Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Women With Severe Aortic Stenosis: The RHEIA Trial
Bibliographic record
Abstract
Background In the RHEIA (Randomized Research in Women All Comers With Aortic Stenosis) trial, the incidence of the primary end point of death, stroke, or rehospitalization at 1 year was lower with transcatheter aortic valve implantation (TAVI) than with surgical aortic valve replacement. The objective of this substudy was to compare echocardiographic findings in women with severe aortic stenosis following surgical aortic valve replacement or TAVI. Methods At 48 European centers, 443 women underwent randomization 1:1, and 420 were treated as randomized. Echocardiograms were available in 356 patients and were analyzed by a core laboratory. Results Rates of or greater moderate paravalvular regurgitation was low (<1%) and similar between groups. At 30 days, TAVI was associated with higher mean transprosthetic gradient and smaller aortic valve area, but the rate of severe patient–prosthesis mismatch (3.0 versus 2.6%; P =1) was low and not different between groups. Valve hemodynamics were stable at 1 year. The rate of residual left ventricular hypertrophy (45.3 versus 28.6%; P =0.004) at 1 year was significantly higher with TAVI, whereas the rate of right ventricular systolic dysfunction (14.5 versus 40.7%; P <0.001) and evolution of cardiac damage stage (improved in 21.8 versus 18.1%; worsened in 16.8 versus 47.0%; P =0.001) were better with TAVI. Conclusions Among women with severe aortic stenosis, both TAVI and surgical aortic valve replacement achieve excellent valve hemodynamic results with low and similar rates of moderate or greater paravalvular regurgitation or severe patient–prosthesis mismatch. Surgical aortic valve replacement was associated with lower gradients and more pronounced regression of left ventricular hypertrophy, whereas TAVI was associated with better right ventricular systolic function and evolution of cardiac damage stage. REGISTRATION URL: https://clinicaltrials.gov/study/NCT04160130 ; Unique Identifier: NCT04160130.
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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 | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 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".