Comparison of Tricuspid Regurgitation Severity Between Cardiac Resynchronization Therapy Versus Right Ventricular Pacing in Patients With Chronic Obstructive Pulmonary Disease
Bibliographic record
Abstract
Background: Right ventricular (RV) lead placement can worsen tricuspid regurgitation (TR). TR is known to be associated with lower survival irrespective of left ventricular ejection fraction (LVEF) or pulmonary hypertension (PH). Patients with chronic obstructive pulmonary disease (COPD) often have PH and pre-existent TR with higher morbidity and mortality from worsening TR. Prior studies are lacking to indicate if cardiac resynchronization therapy (CRT) may be more beneficial in lessening TR in COPD patients. Therefore, we sought to study if patients with COPD will have less TR with CRT versus non-CRT devices. Methods: We performed a retrospective, single-center analysis on 154 COPD patients (mean age = 71.69 ± 10.58, males = 54.14%) that required single-chamber (n = 27), dual-chamber (n = 90), or CRT (n = 37) devices. TR severity, LVEF and right ventricular systolic pressure (RVSP) were evaluated by two cardiologists in a blinded fashion. Analysis of variance (ANOVA) and Chi-square tests were applied for continuous and categorical variables respectively. The primary endpoint was a change in the severity of TR comparing pre-device versus post-device echocardiogram. Secondary endpoints included changes in LVEF and RVSP. Results: COPD patients, who underwent a CRT device had a significantly lower incidence of worsening TR (16%) when compared to single- (37%) (P = 0.001) and dual-chamber devices (30%) (P = 0.02). The increase in RVSP was similar between the groups. There was an expected improvement in LVEF in the CRT group. Conclusions: COPD patients receiving a CRT device were least likely to have worsening TR, compared to single- or dual-chamber devices. Since both COPD and progression in TR may result in poor outcomes, our study may suggest that an upfront strategy of CRT rather than a single- or dual-chamber device may be more beneficial in COPD patients, especially with pre-existent TR.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".