5113 Investigation And Management Of Primary Aldosteronism With Adrenal Vein Sampling At The CHU De Québec-Université Laval
Bibliographic record
Abstract
Abstract Disclosure: A. Boisvert: None. J. Coll: None. N. Gagnon: None. A. Lamarre: None. Background: Adrenal vein sampling (AVS) is the gold-standard test to assess for lateralization in primary aldosteronism (PA). In case of unsuccessful right adrenal vein (RAV) cannulation, our tertiary care centre (CHU de Québec-UL) uses a multinomial regression model to extrapolate the RAV cannulation results. Objectives: 1) To determine the proportion of successful RAV cannulation during AVS at the CHU de Québec-UL; 2) To evaluate the management and clinical evolution of patients with PA who underwent AVS at the CHU de Québec-UL, including those who were treated based on the multinomial regression model results. Methods: This retrospective cohort study included patients aged ≥18 years with a diagnosis of PA who underwent AVS between January 2017 and September 2022 at the CHU de Québec-UL. Epidemiological data at diagnosis were collected, as well as data on AVS cannulation, AVS complications and PA clinical evolution. Successful RAV cannulation was determined by the interventional radiologist and by cortisol ratios. Results are presented as percentage or mean±SD. Results: 39 patients were included (33,3% women; mean age 51,1±11,5 years; 89,7% with hypertension treated with a mean of 2,5±1,1 antihypertensive drugs; 74,4% with hypokalemia), for a total of 40 AVS procedures. 3 procedures (7,5%) selectively cannulated both adrenal veins. 3 procedures (7,5%) led to complications (subcutaneous hematoma). Of the 33 incomplete AVS procedures, the clinical management after 6 of these procedures was unavailable due to follow-up in other hospital centres. Among the remaining 27 patients, 5 (18,5%) had a second complete AVS in another tertiary care center, 12 (44,4%) were medically treated, 1 (3,7%) had an adrenalectomy and 11 (40,7%) were treated according to the multinomial regression model results. The model lateralized aldosterone secretion in 5 patients, who then all had adrenalectomy, after which 4 were diagnosed adrenal adenomas and one was diagnosed adrenal hyperplasia on pathology. The 8 complete AVS procedures led to 6 diagnoses of unilateral disease and 2 diagnoses of bilateral disease. Applying the multinominal regression model to the initial AVS procedure of these 8 cases would have correctly predict aldosterone lateralization in 7 cases (87,5%). Conclusion: AVS success rate in our tertiary care centre was low. The multinominal regression model appeared to adequately detect unilateral disease in our small sample. It is necessary to reevaluate our AVS technical protocol to increase our AVS successful cannulation rate. Presentation: 6/1/2024
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 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".