Association between body mass index, left ventricular remodeling, and long term outcome in patients with bicuspid aortic valve
Bibliographic record
Abstract
Abstract Introduction The obesity paradox, i.e. higher body mass index (BMI) being associated with improved outcome, has never been examined in patients with bicuspid aortic valve (BAV). Purpose To explore the association between BMI and outcome and the possible influence of left ventricular (LV) remodeling in a large cohort of BAV patients. Methods From a multicentre registry adult patients diagnosed with BAV were included. Patients were stratified into normal weight (<25 kg/m2), overweight (≥25 and <30 kg/m2), and obesity (≥30 kg/m2). Clinical and echocardiographic characteristics were collected, and LV hypertrophy was defined as a LV mass index of >115 g/m2 in males and > 95 g/m2 in females. LV remodeling was then further classified as: (i) normal geometry (no LV hypertrophy and relative wall thickness [RWT] ≤0.42); (ii) concentric remodeling: no LV hypertrophy, RWT>0.42; (iii) concentric hypertrophy: LV hypertrophy, RWT>0.42; and (iv) eccentric hypertrophy: LV hypertrophy, RWT≤0.42. The primary outcome was 10-year all-cause mortality. Aortic valve replacement during follow up was coded as a time-dependent covariate. Results A total of 4533 patients (mean age 49±17 years, 29% female) were included. The normal weight, overweight, and obesity group had 1751, 1598, and 812 patients, respectively. These 3 groups showed significant clinical and echocardiographic differences (Figure 1). In particular, obese patients had the lowest prevalence of significant aortic regurgitation (overall P<0.001), and the highest frequency of significant aortic stenosis (overall P=0.028). Also, LV remodeled significantly differently across the BMI spectrum (overall P<0.001), where the obese patients demonstrated the lowest proportion of eccentric hypertrophy but the highest frequency of concentric remodeling. During a median follow up of 2019 (769, 3600) days, 349 events occurred. Overweight patients showed the best survival, demonstrated by the U-shaped restricted cubic spline curve (Figure 2). In the multivariable analysis adjusting for age, sex, comorbidities, LV ejection fraction, significant aortic valve disease, aortopathy, and surgery, both the BMI category (overweight as reference, normal weight: HR 1.44, 95%CI 1.04-2.00, P=0.027; obesity: HR 1.63, 95% CI 1.11-2.39, P=0.012) and LV remodeling patterns (concentric remodeling: HR 1.87, 95% CI 1.17-2.97, P=0.008; concentric hypertrophy: HR 1.77, 95% CI 1.15-2.73, P=0.009; eccentric hypertrophy: HR 1.04, 95% CI 0.62-1.73, P=0.89) were independently associated with 10-year mortality. Conclusions In BAV patients, BMI is associated with different extents of LV hypertrophy. Obese patients are more likely to present with concentric remodeling and less likely with eccentric hypertrophy. The association between BMI and mortality appeared to be "U-shaped", with overweight patients having the most favorable survival even after adjusting for important covariates.
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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 | 0.000 | 0.002 |
| 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) | 0.001 | 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".