The Obesity Paradox in Patients Undergoing Surgical Repair of Degenerative Mitral Regurgitation
Bibliographic record
Abstract
Background: The obesity paradox describes the beneficial influence of an elevated body mass index on health outcomes. Currently, few studies have evaluated BMI and its impact on survival following surgical repair of degenerative mitral regurgitation (MR). Methods: Between 2004 and 2021, 1214 patients underwent surgical mitral valve repair at our institution for MR due to myxomatous degeneration. Results: Patient age was 63.2 ± 12.3 years, 341 (28%) were female, and 678 (55%) were either overweight or obese (body mass index ≥ 25 kg/m2) preoperatively. Concomitant coronary revascularization was performed in 152 (13%). Clinical and echocardiographic follow-up averaged 4.5 years and was complete for all patients. Perioperative mortality occurred in 4 (0.3%). Ten-year survival, freedom from recurrent MR ≥ 2+, and freedom from recurrent MR ≥ 3+ was 75.1 ± 2.3%, 85.8 ± 2.1%, and 96.6 ± 1.0%, respectively. A higher body mass index was associated with better survival (hazard ratio 0.99, 95% CI 0.98–0.99, p = 0.02) after adjusting for age, sex, preoperative LV function, and preoperative LV size. Conclusions: A higher BMI was associated with better long-term survival independent of age, gender, LV function, and LV size. These data may provide nuanced risk prognostication in patients undergoing surgical mitral repair.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".