Registro Multicêntrico Brasileiro de Ablação Septal Alcoólica em Pacientes com Miocardiopatia Hipertrófica Obstrutiva Sintomática – Registro BRASA
Bibliographic record
Abstract
BACKGROUND: Alcohol septal ablation (ASA) is an alternative to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) and significant left ventricular (LV) outflow tract (LVOT) obstruction. Although widely studied worldwide, data on ASA outcomes in Brazil are still limited. OBJECTIVE: To assess the safety and effectiveness of ASA in symptomatic HOCM patients receiving optimal medical therapy using current techniques across multiple centers in Brazil. METHODS: Patients with HOCM and angina (classified by the Canadian Cardiovascular Society [CCS]) or dyspnea (classified by the New York Heart Association [NYHA]) class >II who did not respond to optimal medical treatment were included. The primary efficacy endpoint was defined as a reduction of more than 50% in the maximum resting LVOT gradient, with a final gradient <50 mmHg. Patients were classified as responders or nonresponders. A p-value <0.05 was considered statistically significant. RESULTS: A total of 41 patients (median age 66.4 years; 73% female) underwent ASA. At baseline, 93.2% were in NYHA class III/IV or CCS class III/IV. The mean LV ejection fraction (LVEF) was 66.4%, and the mean LVOT gradient was 88.4 mmHg. After 12 months, 92.8% had improved to NYHA class I/II or CCS class I/II (p<0.01). The mean LVOT gradient dropped from 88.4 mmHg to 27.0 mmHg (p=0.003), and interventricular septum (IVS) thickness decreased from 19.3 mm to 14.7 mm (p=0.048). Responders had lower baseline gradients (73.4 vs 112.6 mmHg, p=0.04) and fewer hospitalizations (21.1% vs 82.4%, p=0.04). Complete atrioventricular block occurred in 16.7% of patients, and 4.8% required pacemakers. No deaths were reported during a median follow-up of 394 days. At the last in-person evaluation, 78.4% were in functional class I/II. CONCLUSIONS: ASA is a safe, effective option for relieving symptoms in selected HOCM patients. It reduces LVOT gradient and septal thickness. Patients with higher baseline gradients were less likely to respond to the procedure.
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".