Survival to Hospital Discharge in the Fetus With Moderate to Severe Mitral Regurgitation Either in Isolation or in Combination With Aortic Valve Stenosis or Atresia, a Fetal Heart Society Collaborative Study
Bibliographic record
Abstract
Background Case series report high mortality after fetal diagnosis of moderate to severe mitral regurgitation in combination with left atrial dilation, hydrops, or restrictive atrial septum. However, overall outcomes and specific high‐risk features remain unclear. Methods We performed a multicenter retrospective cohort study of fetuses with ≥moderate mitral regurgitation and normal cardiac connections evaluated January 1, 2005 to January 31, 2016. Fetuses undergoing fetal cardiac intervention (FCI) were described separately. We assessed associations between fetal echocardiographic features and discharge mortality using mixed logistic regression and classification and regression tree modeling, stratified by studies performed <28 and ≥28 weeks gestational age (GA). Results Of 67 fetuses, 96% had aortic valve stenosis or atresia. Among the non‐FCI group, fetal and discharge mortality was 10% (5/51) and 55% (28/51), respectively. For echocardiograms performed <28 weeks GA, only restrictive atrial septum (odds ratio [OR], 49.6 [95% CI, 5.6–437.5]) and earlier GA at referral (OR 0.72 per increasing week GA [95% CI 0.54–0.96]) remained associated in multivariable analysis. For those ≥28 weeks GA, in multivariable analysis, left atrial dilation (OR, 12.41 [95% CI, 2.19–70.33]) and lower ascending aortic Z score (OR per 1 unit increase, 0.61 [95% CI, 0.39–0.94]) remained in the model. By classification and regression tree modeling, left atrial dilation, restrictive atrial septum, and ascending aortic Z score <−1.3 were the key discriminators between survivors and nonsurvivors. Most FCIs were aortic valvuloplasty (13/16). Discharge mortality among FCI fetuses was 38%, not significantly different from non‐FCI once adjusting for mitral regurgitation and LA dilation. Conclusions Fetal ≥moderate MsR is associated with high mortality. Left atrial dilation, restrictive atrial septum, and smaller ascending aorta confer highest risk for mortality.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".