Abstract 13409: Left Ventricular Remodeling and Function Following Aortic Valve Replacement for Low-Flow, Low-Gradient Aortic Stenosis With Preserved Ejection Fraction-Results From the TOPAS Study
Bibliographic record
Abstract
Background: Aortic valve replacement (AVR) is recommended (IIa) in symptomatic patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG AS). This entity is characterized by pronounced LV concentric remodeling with impaired LV filling and reduced LV longitudinal systolic function and stroke volume despite preserved LV ejection fraction (p-EF). However, there is lack of data about the evolution of LV geometry and function following AVR in these patients. Methods: We prospectively enrolled thirty-two patients (age=71±12 years; 59% men) with PLF-LG AS (SVi<35 mL/m2, mean gradient<40 mmHg, indexed aortic valve area [AVA] 50%) who underwent AVR within 3 months following inclusion. Stroke volume was measured in the LV outflow tract by pulsed-wave Doppler and indexed for body surface area (SVi). Global left ventricular longitudinal strain (GLS) was measured by 2D speckle tracking. Results: Following AVR, mean gradient decreased (15±8 mmHg post vs. 30±7 pre AVR) and AVA increased significantly (1.40±0.31 vs. 0.70±0.12 cm2) (all p<0.0001). AVR was associated with a positive LV remodeling with an increase in LV end-diastolic diameter (46±4 vs. 44±4 vs mm; p=0.0027) and volume (99±21 vs. 89±20 ml, p=0.003) and a decrease in relative wall thickness (0.46±0.06 vs. 0.58±0.11; p=0.0004) and LV mass (175±37 vs. 207±44 g; p=0.002). SVi increased significantly from baseline to 1 year (36±7 vs. 31±3 ml/m2; p=0.0002), whereas LVEF remained unchanged (63±6 vs 63±7; p=NS). SVi increased significantly in the subset of patients with mild to moderate DD at baseline (all p<0.05) but not in those with severe DD (p=NS). GLS also increased significantly from baseline to 1 year (17±4 vs. 14.5±4%; p=0.03). There was a significant correlation between post-AVR increase in GLS and increase in SVi (r=0.52; p=0.02). Conclusion: The findings of this study demonstrate that in patients with PLF-LG AS and p-EF, AVR is associated with an increase in LV stroke volume which is mainly due to positive LV remodeling and improvement in LV longitudinal systolic function. Our results provide further support to the ACC/AHA recommendations with regard to indication of AVR in these patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".