Ventricular septum curvature ratio: a novel imaging marker to predict clinical deterioration in normotensive acute pulmonary embolism
Bibliographic record
Abstract
BACKGROUND: Identifying high-probability deterioration individuals at the time of admission remains a challenge in normotensive patients with acute pulmonary embolism (PE). Ventricular septum (VS) deviation, as observed on computed tomography pulmonary angiography (CTPA), has been associated with poor prognosis in acute PE patients. However, the quantitative relationship between the VS curvature ratio and clinical deterioration in normotensive acute PE patients has not been fully explored. This study aimed to investigate the role of the VS curvature ratio derived from CTPA as an image marker for deterioration in normotensive acute PE patients. METHODS: This prospective multicenter cohort study enrolled normotensive patients with acute PE across five centers in China between January 2021 and June 2024. The VS and left ventricle (LV) free-wall curvature radii were measured using CTPA, and the VS curvature ratio was calculated and categorized. The endpoint was the occurrence of clinical deterioration event within 30 days after admission. The relationship between the VS curvature ratio and deterioration was analyzed using hierarchical logistic regression. The efficacy of identifying deterioration was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Of 3,310 patients, 272 (8.2%) experienced deterioration. In 3,030 patients from three centres, VS were categorized into four groups: VS bowing to the RV with its curvature ratio as < 1.60, 1.60-<1.90, ≥ 1.90, respectively; and the fourth group with VS straight or bowing to the LV. Using a VS curvature ratio < 1.60 as the reference, patients with higher VS curvature ratios had an increased risk of deterioration (odds ratio: 22.94 for ≥ 1.90 and 22.95 for VS straight & bowing to the LV, both p < 0.05). The VS curvature ratio demonstrated good discrimination for deterioration, with an AUC of 0.83 in the three local centers and 0.84 in the two non-local centers (280 patients). CONCLUSIONS: The VS curvature ratio, derived from CTPA images, is a promising image marker for predicting deterioration in normotensive acute PE patients. This study highlights the potential clinical impact of VS curvature ratio to identify normotensive PE patients at increased risk of deterioration and to adjust management strategies accordingly. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05098769, October 16,2021, retrospectively registered.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 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".