Transcatheter aortic valve replacement significantly reduced left ventricular mass index (151.6 vs 171.7 g/m², p<0.001) and improved global longitudinal strain at one month post-procedure.
Cohort (n=199)
Does TAVR improve left ventricular myocardial work indices and how do they correlate with baseline right ventricular function in patients with severe aortic stenosis?
TAVR improves left ventricular myocardial work efficiency at one month, and preserved baseline right ventricular function predicts better post-procedural LV myocardial performance.
Absolute Event Rate: 151.6% vs 171.7%
p-value: p=<0.001
Abstract Background Transcatheter aortic valve replacement (TAVR) has been shown to promote left ventricular (LV) reverse remodeling and functional improvement in patients (pts) with severe aortic stenosis (AS). Evidence regarding its impact on LV performance assessed by advanced speckle-tracking echocardiography (STE) is still limited. We aimed to evaluate the short-term effects of TAVR on LV remodeling and to explore the relationship between post-procedural myocardial work (MW) indices and baseline echocardiographic parameters. Methods We enrolled 199 pts with severe AS who underwent TAVR between 2017-2024. A comprehensive echo was performed just before and one month after the procedure, including STE for myocardial deformation analysis. Complete data on myocardial mechanics was available in 40 pts(75.8±7.6 yrs, 67.5%men). For the calculation of MW indices–global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE), the LV pressure was estimated non-invasively by adding the mean aortic gradient to the brachial systolic pressure to adjust for LV afterload. Results Following TAVR, a significant reduction in LV mass index(LVMi) was observed (151.6±39.6 vs 171.7±47.9g/m²,p0.001). LV systolic function improved- reflected by increase in LVEF (55.3±9.4 vs 51.8±11.5%,p0.001) and decrease in global longitudinal strain (GLS−14.3±3.7 vs−12.5±4.1%,p 0.001). Right ventricular (RV) function parameters improved significantly post-TAVR: RV S’(p0.001), RV GLS(p0.001) and RV free wall strain(FWS p 0.004). Post-TAVR values were significantly lower for GWI (1621.9±480 vs 1938.8±714 mmHg%,p 0.004), GCW (1929.4±548 vs 2360.1±769 mmHg%,p 0.001) and GWW (154.1±72 vs 216.2±78 mmHg%,p0.001), while GWE increased (91.8±3.3 vs 89.9±5.7%, p 0.02). RV function parameters -including TAPSE, RV S’, RV GLS and RV FWS- showed significant correlations with GWI, GCW and GLS. In multivariable analysis, RV GLS emerged as an independent predictor of GWI (β −0.51, p 0.006), while TAPSE independently predicted GCW (β 0.41, p 0.01). Both RV S’ (β −0.45,p 0.002) and LA reservoir strain (β −0.48,p 0.001) independently predicted LV GLS after TAVR. Conclusion Our study showed a significant reduction in LVMi and improvement in GLS shortly after TAVR, accompanied by decreases in GWI and GCW, likely reflecting the abrupt relief of aortic valve obstruction. GWE increased and GWW decreased significantly post-procedure, indicating enhanced myocardial efficiency characterized by improved deformation and reduced mechanical stress. The observed correlations between pre-TAVR RV longitudinal function parameters and post-TAVR LV GLS and MW indices could suggest that preserved RV function prior to valve implantation may promote more effective LV myocardial performance following TAVR. These findings underscore the concept of ventricular interdependence and highlight the prognostic value of RV function assessment in predicting LV recovery after TAVR.
Nita et al. (2026) conducted a cohort in Severe aortic stenosis (n=199). Transcatheter aortic valve replacement (TAVR) vs. Baseline (pre-procedure) was evaluated on Left ventricular mass index (LVMi) (p=<0.001). Transcatheter aortic valve replacement significantly reduced left ventricular mass index (151.6 vs 171.7 g/m², p<0.001) and improved global longitudinal strain at one month post-procedure.