Progression of left ventricular mass is associated with clinical events in key subgroups of Fabry disease: Analyses from the Fabry Registry
Bibliographic record
Abstract
Introduction Cardiovascular complications are the primary cause of morbidity and mortality in Fabry disease. Despite disease-specific and adjuvant treatments, gaps in care exist. Cardiac imaging facilitates the understanding of disease progression, however data on the clinical relevance of imaging endpoints in Fabry disease are scant. Therefore, we evaluated the association between left ventricular mass index (LVMi) measured via echocardiography and risk of subsequent clinical events. Methods Adult patients from the Fabry Registry treated with enzyme replacement therapy, with echocardiography measurements and no prior kidney events were analyzed. Composite clinical events included cardiac, cerebrovascular, and kidney events, or death. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for the association between (1) baseline LVMi and (2) LVMi progression (i.e., slopes) with the risk of subsequent clinical events. Results Baseline LVMi analysis included 809 patients (53.1 % females) with median age at diagnosis [25th, 75th percentile]: 39.5 years [26.7, 52.2]) who had 248 clinical events, including 170 cardiac events, over 4752 and 5128 person-years, respectively. Higher baseline LVMi was associated with greater risk of composite clinical and cardiac events (adjusted HR per 10 % higher baseline LVMi: 1.09 [95 % CI: 1.04–1.13; p < 0.001] and 1.11 [95 % CI: 1.06–1.17; p < 0.0001], respectively). LVMi slope analysis included 377 patients with median 3-year LVMi slope [25th, 75th percentile] of −0.5 g/m 2 /year [−7.8, 7.2]; and evaluated 86 composite clinical events and 57 cardiac events, over 1899 and 2028 person-years, respectively. Increasing LVMi slope was associated with higher incidence of clinical events in key subgroups including in those with the classic Fabry phenotype, those with left ventricular hypertrophy (LVH) at baseline, those with pre-baseline clinical events and in patients with history of hypertension; adjusted HR per 10 g/m 2 /year increase in LVMi slope ranged from 1.16 to 1.64 ( p < 0.05). Conclusions Our study quantifies the biologically plausible association between LVMi and its progression with composite clinical events, including in key subgroups of Fabry patients.
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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 | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".