Left and Right Heart Remodelling at 1 Year After Transcatheter Versus Surgical Aortic Valve Replacement: A...

Speckle-tracking echocardiography (STE) identifies subclinical myocardial dysfunction after aortic valve replacement. We compared strain-based remodelling and prognostic values after transcatheter (TAVR) vs surgical (SAVR) aortic valve replacement.

We analysed preoperative (preop) and postoperative (postop) left atrial volume index (LAVI), left ventricular (LV) global longitudinal strain (LV-GLS), right ventricular (RV) free wall strain (RV-FWS), RV global longitudinal strain (RV-GLS), and tricuspid annular plane systolic excursion (TAPSE) in 373 patients (TAVR n = 195; SAVR n = 178). Multivariable logistic regression assessed echocardiographic predictors of 1-year clinical outcomes.

Left ventricular ejection fraction and LV-GLS remained stable in both groups. Right ventricular function deteriorated post-SAVR compared to TAVR (P < .001), with marked declines in TAPSE and RV-GLS (both P < .001). Preop LAVI predicted mortality (adjusted OR, 1.03; 95% CI, 1.02-1.05; P = .001) and atrial fibrillation (AF) recurrence (OR, 1.04; 95% CI, 1.02-1.06; P = .001). Stroke was predicted by preop RV-GLS (OR, 0.91; P = .031) and TAPSE (OR, 1.12; P = .013). Postop LAVI (OR, 1.06; P = .001), RV-FWS (OR, 1.06; P = .016), RV-GLS (OR, 1.10; P = .006), and TAPSE (OR, 0.93; P = .035) also remained significant predictors. Furthermore, postop LV-GLS was associated with mortality (OR, 1.08; P = .013) and AF recurrence (OR, 1.16; P = .001).

Preop and postop strain parameters, particularly LAVI, LV-GLS, and RV longitudinal metrics, provide substantial prognostic value. Divergent RV remodelling patterns support integrating routine echocardiographic strain assessment for longitudinal risk stratification.