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Estimation of Residual Valve Gradient from Incomplete Data with Outliers

An important indicator for the long‐term recovery after valve replacement surgery is postoperative valve gradient. This information is available only for patients received catheterization or echocardiogram postoperatively. It is plausible that sicker patients are more inclined to undergo these postoperative procedures and their valve gradients tend to be higher. Under this situation, ignoring the missing values and using sample mean based on the available information as an estimate of the whole study population leads to overestimation. Regression estimator is a reasonable choice to eliminate this bias if independent (explanatory) variables closely associated with both residual valve gradient and non‐response mechanism can be identified. Using a series of patients receiving St. Jude Medical prosthetic valves, we found that valve area index can be used as an independent variable in the regression estimator. Two digressions from the standard assumptions used in linear regression, heteroscedastic trend of the error term and outliers were found in the data set. Iteratively reweighted least square (IRLS) was adopted to handle heteroscedasticity. Influence function approach was used to evaluate the sensitivity of outliers in regression estimator. Under an equal response rate mechanism, IRLS not only solves the problem of heteroscedasticity, but is also less sensitive to outliers.