Left Atrial Functional Parameters and Left Ventricular Reverse Remodeling After Aortic Valve Replacement in Severe Aortic Stenosis

Left ventricular reverse remodeling (LVRR) after aortic valve replacement (AVR) varies in severe aortic stenosis (AS). We evaluated whether preoperative left atrial (LA)-derived functional indices were associated with structural LVRR (S-LVRR) and functional LVRR (F-LVRR).

This retrospective 2-center study included 139 adults with severe AS undergoing surgical or transcatheter AVR and follow-up echocardiography after a median of 6.1 months. S-LVRR was defined as normalization of left ventricular (LV) mass index, and F-LVRR as sex-specific recovery of absolute LV global longitudinal strain. Separate adjusted logistic models assessed LA reservoir strain (LASr), LA stiffness index (LASI), LA reservoir work, and LA volumetric/mechanical coupling index, with supportive sensitivity analyses.

S-LVRR and F-LVRR occurred in 58 (41.7%) and 42 (30.2%) patients, respectively. Higher LASr and lower LASI were independently associated with S-LVRR (odds ratio [OR] per 1-standard deviation increase, 2.48; 95% confidence interval [CI], 1.37-4.49 and OR, 0.32; 95% CI, 0.13-0.79) and F-LVRR (OR, 7.41; 95% CI, 2.70-20.32 and OR, 0.01; 95% CI, 0.00-0.15). LASr remained robust across sensitivity analyses, whereas LASI was attenuated in change-based analyses.

In severe AS, preserved preoperative LASr and lower LASI were associated with postoperative LVRR after AVR. LASr was the most consistent LA-derived marker and may complement conventional LV assessment pending prospective validation.