Noninvasive Myocardial Work for Assessing Left Ventricular Function After TAVI in Pure Aortic Regurgitation: An...

Noninvasive myocardial work (MW), based on speckle-tracking technology and incorporating left ventricular (LV) afterload, significantly reduces the load dependency of parameters. MW has been widely used to assess LV function after TAVI in patients with aortic stenosis (AS); however, its application in this context for pure aortic regurgitation (AR) remains rare. This study aims to (1) assess the specific and overall trends of conventional echocardiographic and MW indices after TAVI in patients with pure AR, providing insight into the process and mid-term outcomes of post-TAVI LV functional improvement in this population; (2) evaluate the post-TAVI functional recovery patterns in patients with preserved vs. reduced left ventricular ejection fraction (LVEF); and (3) explore the relationship between MW indices and LV reverse remodeling (LVRR) following TAVI in patients with pure AR.

In this prospective cohort study, 43 patients with pure AR who underwent TAVI between January 2023 and July 2024 were enrolled. Serial transthoracic echocardiography was performed at baseline and at 1 week, 1 month, 3 months, and 6 months post-TAVI. Conventional echocardiographic parameters and noninvasive MW indices were analyzed offline.

LVEF, LVGLS, LVGWI, LVGCW, and LVGWE exhibited an overall trend of initial decline followed by subsequent improvement after TAVI, whereas GWW showed an initial increase followed by a decrease. In contrast, LVEDD and LVEDV demonstrated a continuous decline throughout the follow-up period. At 6 months post-TAVI, LVGWI, LVGCW, and LVGWE were significantly reduced, while LVGWW was significantly increased compared with baseline (all p < 0.05). At baseline, post-TAVI, and at 6-month follow-up, LVGLS, LVGWI, and LVGCW were all significantly higher in the LVRR group compared to the non-LVRR group (p < 0.05).

TAVI effectively improves LV function in pure AR, irrespective of baseline LVEF. Noninvasive MW analysis proved to be an effective tool for assessing postoperative improvements in LV myocardial function. The reduction in MW indices at 6 months post-TAVI may reflect partial recovery rather than functional deterioration. Better MW indices at baseline may be associated with LVRR.