Abnormal coronary anatomy in patients with atrial switch: a predictor of serious cardiac adverse event?
Bibliographic record
Abstract
Abstract Introduction Sudden death and heart failure are severe long-term complications after atrial switch for D-transposition of the great arteries (D-TGA). Mechanisms and factors of long-term complications are poorly known. Right ventricle ischemia may be involved in these complications. Since coronary malformations are present in about 30% of D-TGA, we aimed to look for an association between these complications and the presence of coronary anomalies. Methods The study is an observational international study in two tertiary centers. Adults with history of atrial switch and severe rhythmic or hemodynamic complications, history of heart transplantation or cardiovascular death were included. Patients under 18 years old and/or with corrected transposition of great arteries were excluded. A χ2 test was used to compare the proportion of coronary anomalies in this cohort to the one from population of D-TGA reported in previous studies. Results Forty-two patients were included: 11 women (26.2%) and mean age at the time of the study was 43.3±6.4 years. Eight patients (19.0%) died at a mean age 41.3±9.0 years. No ablation for ventricular tachycardia was reported while 15 (35.7%) patients underwent ablation for a SVT (supraventricular tachycardia). Thirty three patients (78.6%) suffered from heart failure and/or severe right ventricle dysfunction and 4 patients (9.5%) were transplanted at a mean age of 29.3±8.3 years. Ten (23.8%) patients suffered from both arrhythmic events and heart failure. Twelve patients (28,6%) had abnormal coronary anatomy. The χ2 test showed no significant difference of coronary anatomy between our population and a pooled population of 647 D-TGA from previous studies (28.7%, p=0.9804). By multivariate analysis, severe pulmonary hypertension and severe tricuspid regurgitation were significantly associated with cardiovascular death and/or heart transplantation (respectively: p=0.0323, OR= 2.5, and p=0.0494, OR= 4.0). SVT ablation tended to be associated to survival (p=0.0928 with OR= 2.2). Conclusions No difference of coronary anomalies ratio in complicated Mustard or Senning patients was seen in comparison with the coronary anomalies ratio of all D-TGA. These results plead against a role of abnormal coronary anatomy in right ventricle dysfunction. Ischemia may be more related with the alteration of micro vascularization and a mismatch between oxygen needs and supply. Funding Acknowledgement Type of funding source: None
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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) | 0.003 | 0.000 |
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".