Effect of Contemporary Optimal Medical Therapy on Patients With Reduced Ejection Fraction Who Have Undergone Surgery for Severe Chronic Aortic Regurgitation
Bibliographic record
Abstract
Background Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) in the presence of reduced left ventricular ejection fraction (LVEF) is associated with higher surgical risk. Long-term outcomes remain poorly described in contemporary cohorts. Methods 122 patients underwent AVR for chronic severe AR with LVEF < 50% between 2004-2019. Patients with severely reduced LVEF (<35%, n=37) were compared to those with mild-to-moderately reduced LVEF (35% to 50%, n=85). Results Preoperative and intraoperative characteristics were similar in both groups. Operative mortality for the entire cohort was 1.6% (n=2) and similar across the LVEF spectrum. Postoperatively, optimal medical therapy was achieved in most patients and more than 25% of patients with LVEF < 35% benefited from cardiac resynchronization therapy. At latest follow-up, mean LVEF was 42±12% in the severely reduced LVEF group (vs. baseline 28±5%, p<0.001) and 51±9% in the mild-to-moderately reduced LVEF group (vs. baseline 46±4%, p<0.001). Freedom from cardiovascular (CV) death at ten years was 87.2% in the severe group and 94.7% in the mild-to-moderate group (p=0.10). Freedom from heart failure (HF) hospitalization at ten years was higher in the mild-to-moderate group (96.3%) than in the severe group (88.3%) (p=0.009). Conclusion In this contemporary cohort of patients undergoing AVR for chronic severe AR, patients with severely reduced LVEF treated with optimal medical therapy had similar operative mortality and freedom from CV death than patients with mild-to-moderately reduced LVEF. Favorable LV remodeling was observed in both groups. Hospitalization for HF was less than 15% in both groups at 10 years follow-up.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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".