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 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 | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
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".