Abstract 13676: Characteristics and Outcomes of Patients With Clinically Significant Valvular Heart Disease and Cardiogenic Shock Admitted to Cardiac Intensive Care Units
Bibliographic record
Abstract
Introduction: Little is known about the characteristics & outcomes of patients (pts) with significant valvular heart disease (VHD) and cardiogenic shock (CS). In addition, differences between pts with CS due to VHD vs VHD as “bystander” to CS have not been described. Methods: The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America coordinated by the TIMI Study Group. Participating centers capture all CICU admissions for 2 months annually. Pts with CS and significant VHD were classified as having CS due to VHD or CS with concomitant VHD not felt to be the cause of CS. Admissions from 2017 - 2021 were analyzed. Results: Of 3,974 CICU admissions with CS, 165 (4.2%) had CS due to VHD and 769 (19.4%) had CS with concomitant VHD. Pts with CS due to VHD were older (71 vs 67 y), less commonly had a hx of HF (47.3% vs 73.1%), & more commonly had LVEF>50% on admission (51.5% vs 16.8%); p<0.001 for all. Resource use varied significantly (Fig). Nearly 1/3 of pts (30.3%) with CS due to VHD underwent surgical/transcatheter valve procedures during CICU admission, contrasting with those with CS and concomitant VHD (13.5%; p<0.001). In-hospital mortality was similar between the 2 VHD groups (39.4% vs 33.8%, p=0.17). In-hospital mortality for allcomers with CS and VHD (concomitant or causative) was higher than in those with CS and no VHD (34.8% vs 29.7%; p=0.003), including adjusted for age, sex, SOFA score, and pre-CICU cardiac arrest (aOR 1.23; 1.03-1.47). Mortality was numerically lower in pts undergoing a valve procedure (23.4% died; 16% with CS due to VHD, 26.9% with CS and concomitant VHD; p=0.13), compared to pts who did not (37.1% overall; 49.6% & 34.9%, respectively; p=0.003). Conclusions: Although VHD is the primary cause of CS in a minority of pts, the presence of significant VHD is associated with higher mortality. In contemporary CICUs, procedural intervention is undertaken in ~1/3 of cases and mortality was numerically lower in pts who underwent valve procedures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 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) | 0.000 | 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 teacher head, 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".