Abstract 11499: Management of Mixed Aortic Valve Disease Patients: Can N-terminal Pro-Brain Natriuretic Peptide Ratio Improve Risk Assessment?
Bibliographic record
Abstract
Introduction: Risk assessment of mixed aortic valve disease (MAVD: concomitant aortic stenosis [AS] and regurgitation [AR]) patients is challenging, especially in non-severe lesions. In fact, these patients often present LV dysfunction after aortic valve replacement (AVR), and concomitant non-severe lesions appear to have similar outcomes than severe AS. Objective: We aimed to evaluate the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) ratio in risk stratification of MAVD patients. Methods: A total of 582 consecutive MAVD patients (mean age 73±11 years, 63% men) with at least concomitant mild AS and AR in whom a measurement of NT-proBNP during the same episode of care was available were included. NT-proBNP ratio (i.e., plasma level divided by maximal normal values for age and sex derived from Mayo Clinic laboratory) was calculated. In subgroups analyses, patients were divided according to MAVD pattern (severe AS or AR [n=364] and non-severe AS/AR [n=218]) and according to treatment strategy (early AVR [i.e., ≤3 months, n=429] or initial medical treatment [MT; n=153]). Results: Baseline median NT-proBNP ratio was 3.5 (IQR: 1.2-10.0). A total of 105 patients died during a median follow-up of 5.6 (2.8-6.1) years. Overall, NT-proBNP ratio ≥3 was significantly associated with long-term all-cause mortality in multivariable analyses adjusted for clinical and echocardiographic parameters as well as AVR as a time-dependent variable . NT-proBNP-ratio also showed incremental prognostic value at 1, 2 and 5 years over EuroSCORE II and echocardiographic parameters (all, net reclassification index >0.45; p≤0.005). In all subgroups, NT-proBNP-ratio ≥3 remained independently associated with excess mortality ( severe AS or AR - HR[95CI]: 3.30[1.54-7.05], non-severe AS/AR : 2.14[1.03-4.43], early AVR : 2.48[1.16-5.39], initial MT : 2.72[1.02-7.22]; all p≤0.04). In patients who underwent early AVR, NT-proBNP-ratio ≥3 was also associated with higher 30-days mortality (9[4%] vs. 1[0.5%], p=0.02). Conclusions: In this series of MAVD patients, NT-proBNP-ratio was a powerful predictor of mortality, even in non-severe lesions, early AVR and medically treated patients. AVR may be reasonable before reaching an NT-proBNP-ratio ≥3.
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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) | 0.001 | 0.000 |
| 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 | 0.000 | 0.001 |
| 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".