Key result
Transcatheter aortic valve replacement better preserved right ventricular function at 1 year compared to surgical aortic valve replacement, which was associated with significant declines in TAPSE and right ventricular strain.
Why the study?
Speckle-tracking echocardiography detects subclinical myocardial dysfunction, but strain-based remodeling and prognostic values had not been compared between TAVR and SAVR.
Does transcatheter aortic valve replacement versus surgical aortic valve replacement differentially impact echocardiographic strain-based left and right heart remodeling and long-term prognostic values in patients with severe aortic stenosis?
Observational (n=373)
No
Does transcatheter aortic valve replacement versus surgical aortic valve replacement differentially impact echocardiographic strain-based left and right heart remodeling and long-term prognostic values in patients with severe aortic stenosis?
Absolute Event Rate: -0.2% vs -4.3%
p-value: p=<0.001
Routine evaluation of echocardiographic strain parameters, specifically LAVI and LV-GLS, provides significant prognostic value for predicting mortality, stroke, and AF recurrence following transcatheter or surgical aortic valve replacement.
OBJECTIVES: Speckle-tracking echocardiography (STE) identifies subclinical myocardial dysfunction after aortic valve replacement. We compared strain-based remodelling and prognostic values after transcatheter (TAVR) versus surgical (SAVR) aortic valve replacement. METHODS: We analyzed preoperative (preop) and postoperative (postop) left atrial volume index (LAVI), LV global longitudinal strain (LV-GLS), RV free wall strain (RV-FWS), RV global longitudinal strain (RV-GLS) and tricuspid annular plane systolic excursion (TAPSE) in 373 (TAVR n = 195; SAVR n = 178). Multivariable logistic regression assessed echocardiographic predictors of one-year clinical outcomes. RESULTS: LV ejection fraction and LV-GLS remained stable in both groups. RV function deteriorated post-SAVR compared to TAVR (p < 0.001), with marked declines in TAPSE and RV-GLS (both p < 0.001). Preop LAVI predicted mortality (adjusted OR 1.03, 95% CI 1.02-1.05; p = 0.001) and AF recurrence (OR 1.04, 95% CI 1.02-1.06; p = 0.001). Stroke was predicted by preop RV-GLS (OR 0.91; p = 0.031) and TAPSE (OR 1.12; p = 0.013). Postop LAVI (OR 1.06; p = 0.001), RV -FWS (OR 1.06; p = 0.016), RV-GLS (OR 1.10; p = 0.006), and TAPSE (OR 0.93; p = 0.035) also remained significant predictors. Furthermore, postop LV-GLS was associated with mortality (OR 1.08; p = 0.013) and AF recurrence (OR 1.16; p = 0.001). CONCLUSIONS: 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.
No takes yet. Share an insight, caveat, or question.
Kislitsina et al. (2026) conducted an observational in Severe aortic stenosis (n=373). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Absolute change in tricuspid annular plane systolic excursion (TAPSE) at 1-year follow-up (measure of echocardiographic right chamber remodeling) (p=<0.001). Transcatheter aortic valve replacement better preserved right ventricular function at 1 year compared to surgical aortic valve replacement, which was associated with significant declines in TAPSE and right ventricular strain.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: