NT-proBNP en el ventrículo derecho sistémico, ¿un nuevo valor de corte para la estratificación del riesgo?
Bibliographic record
Abstract
Introducción y objetivos: El objetivo de este estudio es analizar el valor pronóstico de la fracción aminoterminal del péptido natriurético cerebral (NT-proBNP) en pacientes con ventrículo derecho sistémico (VDs). Métodos: El valor pronóstico de la NT-proBNP se evaluó en 98 pacientes del ensayo clínico SERVE. Se empleó un modelo de riesgos proporcionales de Cox ajustado, análisis de supervivencia y estadístico c. El objetivo primario compuesto fue la ocurrencia de arritmia clínicamente relevante, insuficiencia cardiaca o muerte. Como objetivos secundarios se evaluaron las correlaciones entre los valores basales de NT-proBNP y los volúmenes y la función biventriculares mediante modelos de regresión lineal ajustados. Resultados: La mediana [intervalo intercuartílico] de edad al inicio fue de 39 [32-48] años y el 32% eran mujeres. La mediana de NT-proBNP fue de 238 [137-429] ng/l. Las cifras basales de NT-proBNP fueron significativamente más altas entre los 20 pacientes (20%) que cumplían el objetivo primario combinado (816 [194-1.094] frente a 205 [122-357] ng/l; p = 0,003). En pacientes con valores de NT-proBNP superiores al percentil 75 (> 429 ng/l), se halló un aumento exponencial en la razón de riesgos ajustada por sexo y edad para el resultado primario. El valor pronóstico del NT-proBNP fue comparable al de la fracción de eyección del ventrículo derecho y al del consumo máximo de oxígeno en la prueba de esfuerzo (estadístico c, 0,71, 0,72 y 0,71 respectivamente). Conclusiones: En pacientes con VDs, los valores de NT-proBNP se correlacionan con los volúmenes y la función ventriculares y pueden ser un medio útil para la estratificación del riesgo. Introduction and objectives The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the risk prediction of patients with systemic right ventricles (sRV) is not well defined. The aim of this study was to analyze the prognostic value of NT-proBNP in patients with an sRV. Methods The prognostic value of NT-proBNP was assessed in 98 patients from the SERVE trial. We used an adjusted Cox proportional hazards model, survival analysis, and c-statistics. The composite primary outcome was the occurrence of clinically relevant arrhythmia, heart failure, or death. Correlations between baseline NT-proBNP values and biventricular volumes and function were assessed by adjusted linear regression models. Results The median age [interquartile range] at baseline was 39 [32-48] years and 32% were women. The median NT-proBNP was 238 [137-429] ng/L. Baseline NT-proBNP concentrations were significantly higher among the 20 (20%) patients developing the combined primary outcome compared with those who did not (816 [194-1094] vs 205 [122-357]; P = .003). In patients with NT-proBNP concentrations > 75th percentile (> 429 ng/L), we found an exponential increase in the sex- and age-adjusted hazard ratio for the primary outcome. The prognostic value of NT-proBNP was comparable to right ventricular ejection fraction and peak oxygen uptake on exercise testing (c-statistic: 0.71, 0.72, and 0.71, respectively). Conclusions In patients with sRVs, NT-proBNP concentrations correlate with sRV volumes and function and may serve as a simple tool for predicting adverse outcomes.
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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 | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".