2024 Annual Congress of the Pulmonary Vascular Research Institute
Bibliographic record
Abstract
Previous studies have demonstrated that patients with aortic stenosis (AS) and pulmonary hypertension have a poorer prognosis.Patients with low-flow, low-gradient aortic stenosis (LFLG AS) and reduced left ventricular ejection fraction (LVEF) are known to have a poor prognosis following transcatheter aortic valve implantation (TAVI).However, the prognostic value of the pulmonary artery systolic pressure (PASP) to stroke volume (SV) ratio in patients with LF-LG AS has not been investigated.This study aims to evaluate the prognostic value of the PASP/SV ratio in patients with LF-LG AS treated conservatively or with aortic valve replacement (AVR).The objective of this study was to determine the prognostic value of the PASP/SV ratio in LFLG-AS patients.Clinical and echocardiographic data were prospectively collected from 381 patients enrolled in the TOPAS (Truly or Pseudo-severe Aortic Stenosis #NCT01835028) study.The cohort was divided into two groups based on a cutoff value of PASP/SV 0.54 mmHg/mL, which showed the optimal prognostic value for predicting 5year outcomes using receiver operating characteristic (ROC) analysis.The mean age of the study population was 73 years, and 66% were male.During a median follow-up of 1.5 (0.6-4.2) years, 143 (37%) patients died.Kaplan-Meier survival curve analysis revealed that patients with a PASP/ SV < 0.54 mmHg/mL vs PASP/SV > 0.54 mmHg/mL had a 5-year survival estimate of 82% and 52%, respectively (logrank p < 0.001).These findings were confirmed through multivariable Cox analysis adjusted for age, sex, BMI, AVR as a time-dependent variable, diabetes, and STS score.Patients with a PASP/SV > 0.54 mmHg/mL had a significantly increased risk of all-cause mortality at 5 years compared to those with a PASP/SV < 0.54 mmHg/mL (HR [95% CI] = 2.17 [1.36-3.46],p = 0.001).The pulmonary resistance index defined as the PASP/SV ratio is independently associated with increased risk of all-cause mortality in patients with LF-LG AS.The PASP/SV ratio may be useful to enhance risk stratification in this challenging population.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.144 | 0.107 |
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".