The orientation of the aortic annulus in patients with a bicuspid aortic valve leads to underestimation of annulus diameter on 2D TTE
Bibliographic record
Abstract
Abstract Background In the setting of bicuspid aortic valve (BAV), the assessment of aortic annulus morphology remains poorly defined. Purpose We aim to evaluate the morphology and orientation of the maximum diameter of the aortic annulus in BAV patients using contrast-enhanced computed tomography. Methods We included 159 BAV patients (male: 75%, mean age 55 ±19): 70 with severe aortic stenosis and 89 with ascending aorta enlargement without significant valvulopathy. All patients underwent transthoracic echocardiography (TTE) and contrast-enhanced computed tomography (CT). Results The annulus was asymmetric (eccentricity index: 0.23±0.09) and the Sievers class was not a determinant of annular eccentricity (type 0: 0.26±0.09 vs. type 1: 0.23±0.08, p=0.068). The aortic annulus maximum diameter orientation was evaluated using CT sagittal plane as a reference. This orientation was not dependent on BAV phenotype: horizontal opening: 109.6±28.6° vs vertical opening 111.2 ±28.8°, p=0.87. This is in contrast with the aortic root maximum diameter which is dependent on the BAV phenotype: horizontal or vertical opening: 71.3±35.5° vs. 122.9±35.5°, p<0.0001. (Figure) As a result, diameter obtained in the parasternal long-axis incidence is always the short axis of the ellipse. Using this measure to calculate the annulus area therefore leads to underestimation of annulus area if eccentricity index is not taken into account. The mean difference of the annulus area using TTE vs CT is 142.2mm² i.e., 32% and 0.62cm² i.e., 29% for the aortic valve area. Conclusion orientation of the maximum aortic annulus diameter is orthogonal to the TTE ultrasound beam in BAV patients, irrespective of BAV type. Our results suggest that TTE can lead to an underestimation of annulus area and, consequently, aortic valve area.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 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".