Abstract 4144724: Native aortic stenosis progression: a focus on sex differences.
Bibliographic record
Abstract
Background: Paucity of evidence is available on sex-differences in the progression, left ventricular (LV) remodelling and long-term outcome in patients with native mild-to-moderate aortic stenosis (AS) and preserved LV ejection fraction (LVEF). Objectives: To assess the sex-differences in the progression, LV remodelling and long-term outcome of native AS. Methods: Baseline and follow-up echocardiographic data of patients with at least mild-to-moderate AS [aortic valve area(AVA)≤1.5 cm2, maximum aortic velocity(Vmax) ≥2.5 m/s or mean gradient(MG)≥25 mmHg] were prospectively collected between 2014 and 2019 and retrospectively analysed. Patients with LVEF<50%, or mitral or aortic regurgitation >mild were excluded. AS progression (analysed by annualized progression ratios in echocardiographic parameters), all-cause death, aortic valve replacement (AVR), were investigated stratifying for sex. Results: We included 677 patients with a mean age of 70.8±13.2 years, 258 (38.1%) women. During a median 5 years follow-up, 118(17.4%) deaths and 211(32.2%) AVR occurred. After inverse-propensity-weighting (IPW), men had faster progression rate of AS compared to women (MG: mean difference 1.77[1.10-2.43] mmHg/year, p<0.0001; and Vmax: mean difference 9.56[5.7-13.4] cm/s/year, p<0.0001). While women had higher annualized progression ratio in LV mass-indexed (mean difference 2.51[4.56-0.45] mg/m 2 /year, p=0.017), relative wall thickness (mean difference 0.007[0.01-0.003], p=0.039), but lower stroke-volume-indexed (SVi) (mean difference 0.80[1.10-2.43]ml/m 2 /year, p=0.012). Similar results were obtained after 1:1 matching. Relative to women, men presented similar incidence of all-cause mortality (HR 1.07[0.72-1.56], p=0.73) and AVR on competitive risk analysis (IPW-Sub Hazard Ratio SHR 0.93 [0.61-1.41], p=0.74). Conclusions: Mild-to-moderate AS in men presented accentuated hemodynamic progression over time; however, women were more likely to develop LV hypertrophic/concentric remodelling accompanied by lower flow. Similar long-term outcomes were observed in men and women. These results emphasize the importance of evaluating LV remodelling and flow pattern in AS, and not only the AS severity. The slower hemodynamic progression of AS observed in women may be linked to their tendency in reducing SVi, due to distinct LV remodelling pattern.
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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 | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 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 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".