Left ventricular dilatation in patients with significant aortic regurgitation: association with outcome
Bibliographic record
Abstract
AIMS: Left ventricular (LV) dilatation is an important prognostic factor in patients with aortic regurgitation (AR). Although current guidelines recommend the use of LV end-systolic diameter index (LVESDi) to indicate the need for intervention, recent studies suggested that LV end-systolic volume index (LVESVi) may more accurately characterize LV remodelling.The present study aims to evaluate, in a multi-centre setting, whether combining LV linear and volumetric measures could improve risk stratification. METHODS AND RESULTS: A total of 1070 patients (56 ± 18 years, 65% male) with significant AR were included. Cut-off values of 20 mm/m2 for LVESDi and 45 mL/m2 for LVESVi were used to identify the following groups: no-significant LV dilatation (n = 485), when both LVESDi and LVESVi were below the cut-off values; discordant LV dilatation (n = 279) if only one positive criterium was present; and concordant LV dilatation (n = 306) when both LVESDi and LVESVi were enlarged. The primary endpoint was all-cause mortality. During a median follow-up of 7.4 (IQR, 4.5-11) years, 168 patients (16%) died, and 484 (45%) underwent aortic valve surgery (AVS). Patients with concordant LV dilatation showed the worst 10-year survival (P < 0.001). Discordant (HR 2.066, 95% CI 1.295-3.298; P = 0.002) or concordant LV dilatation (HR 2.759, 95% CI 1.616-4.710; P < 0.001) was independently associated with higher mortality compared with patients with no-significant LV dilatation after adjusting for relevant clinical and echocardiographic variables and regardless of AR severity. However, both groups showed greater benefit from AVS. LV dilatation, either concordant or discordant, was also independently associated with outcome in asymptomatic patients and those with left ventricular ejection fraction > 55%. CONCLUSION: In patients with significant AR, the presence of LV dilatation detected by linear and/or volumetric measures was independently associated with increased mortality.
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 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".