Left ventriculo-arterial coupling in a contemporary cohort of patients with wild-type transthyretin cardiac amyloidosis treated with tafamidis
Bibliographic record
Abstract
Abstract Background Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is characterized by a labile equilibrium between preload and afterload. A tailored approach to supporting medical therapy based on noninvasive parameters able to describe the properties of both heart and systemic vasculature, and their interactions is required. However, data on ventriculo-arterial coupling (VAC) in ATTRwt-CM is lacking. Objectives To describe ventriculo-arterial coupling (VAC) and its clinical correlates in a contemporary cohort of patients with ATTRwt-CM. Methods The VAC, defined as the ratio between arterial ( E a ) and ventricular elastance ( E es ) was evaluated noninvasively using the single-beat algorithm based on arm cuff blood pressure, Doppler stroke volume, pre-ejection time and total ejection time. Results The study included 114 patients treated with the transthyretin stabilizer tafamidis from a national referral centre (median age 79 years; 89% males). Median values were 1.48 (1.22–1.84) mmHg/ml for E a , 1.86 (1.49–2.29) mmHg/ml for E es , and 1.24 (0.96–1.58) for VAC. Patients with upper-tertile VAC showed worse clinical (National Amyloidosis Centre (NAC)/Mondor stage, p < 0.001), laboratory (NT-pro-B-type natriuretic peptide levels, p < 0.001), instrumental features (left ventricular ejection fraction and stroke volume, p = 0.0001 for both), and they received more intensive heart failure supportive therapies. The E a / E es ratio, but not its single components, was associated with NT-proBNP levels. Finally, the E a / E es ratio was an independent determinant of a high NAC/Mondor stage at both univariate (OR[95% CI]:15.39[3.51–67.35], p < 0.001) and multivariate (OR[95% CI]:11.26[1.98–63.81], p = 0.006) logistic regression analyses. Conclusion In ATTRwt-CM patients, arterial and ventricular elastances and VAC are independent predictors of worse clinical status and more advanced disease stage. Graphical Abstract
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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 | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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".