Left ventricular remodeling following transcatheter versus surgical aortic valve replacement: a speckle tracking...

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative and less invasive treatment to surgical aortic valve replacement (SAVR). Left ventricular global longitudinal strain (LV-GLS) can reveal changes in left ventricular performance before involvement of ejection fraction. Our aim was to present and evaluate our center's experience regarding short- and long-term reverse left ventricular remodeling using two-dimensional-speckle tracking echocardiography-derived LV-GLS after TAVI compared with SAVR.

Our multidisciplinary cardiac team carefully evaluated 65 patients for SAVR who presented with severe symptomatic aortic stenosis and who had high, intermediate, or low surgical risk. The patients underwent either TAVI with an Evolut-R self-expanding valve or SAVR. Echocardiographic evaluation was performed before, 1 month, and 1 year after the procedure.

TAVI was performed in 31 patients and SAVR in 34 patients. The incidence of valvular and paravalvular leak was higher in the TAVI group despite early favorable LV remodeling with a significant decrease in left ventricular mass index and E/e' shortly after the procedure and an early detectable improvement in LV-GLS from -8.18 ± 1.81 to -14.52 ± 2.52, reaching -16.12 ± 2.69 at 1 year (P < .001). This early improvement was not observed in the SAVR group. TAVI preserved right ventricular function without affecting tricuspid annular plane systolic excursion or increasing estimated pulmonary artery pressure.

Patients who underwent TAVI had earlier and significantly better LV remodeling with early reduction in left ventricular mass index, E/e' ratio, and significant early improvement in LV-GLS without concomitant impairment of left ventricular ejection fraction percentage or deterioration of right ventricular function.