Left Atrial Stiffness Is Increased in Pediatric Hypertrophic Cardiomyopathy and Offers Incremental Value in Predicting Major Adverse Cardiac Events in This Group
Bibliographic record
Abstract
Background Determining risk factors by echocardiography to prevent major adverse cardiac events (MACE) is crucial in pediatric patients with hypertrophic cardiomyopathy. Recent studies have shown that left atrial (LA) stiffness may serve as surrogate marker in children, to differentiate elevated pulmonary capillary wedge pressure from normal. Methods We retrospectively enrolled 239 pediatric patients with hypertrophic cardiomyopathy. They were divided into 2 groups: MACE (n=79) and non‐MACE (n=160) groups. Noninvasive LA stiffness was calculated as the ratio of average E/e′ to peak LA strain obtained by 2‐dimensional speckle‐tracking echocardiography. Baseline evaluation was defined as the echocardiogram performed at the time of referral, before the occurrence of a MACE, including appropriate implantable cardioverter‐defibrillator intervention, myomectomy, heart transplant, or cardiac death. Results The MACE group showed significantly decreased left ventricular peak longitudinal strain compared with the non‐MACE group, with no significant difference in left ventricular ejection fraction. Peak LA strain was significantly reduced (22.5±7.1% versus 30.4±7.3%; P <0.001), whereas LA stiffness was significantly increased (median 0.57 [IQR, 0.37–0.91]% −1 versus 0.31 [IQR, 0.22–0.42]% −1 ; P <0.001) in the MACE group. LA stiffness was the superior‐most index for predicting MACE (C‐index, 0.75; cutoff value, 0.31% −1 ), and even in cross‐validation, the C‐index consistently demonstrated the highest predictive ability (LA stiffness, 0.746 [95% CI, 0.737–0.753]). Moreover, LA stiffness was independently associated with increased risk of MACE (HR, 1.12 [95% CI, 1.07–1.17]; P <0.001). Conclusions LA stiffness is a newly described index, which may be of incremental value in predicting risk of MACE in pediatric patients with hypertrophic cardiomyopathy.
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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 | 0.000 |
| 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) | 0.001 | 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".