Key result
TAVI significantly reduced LAVi (41 to 37 mL/m2, p=0.003) and increased A-wave velocity (102 to 109 cm/s, p=0.0008), while LASr did not change significantly (18.8% vs 20.5%, p=0.22).
Why the study?
Assessing LV diastolic function in patients undergoing TAVI is challenging, and available data on post-TAVI diastolic changes remain inconsistent. This study investigated changes in diastolic function according to the 2025 ASE guidelines and evaluated the incremental diagnostic value of newly recommended left atrial reservoir strain (LASr).
Does transcatheter aortic valve implantation (TAVI) improve echocardiographic parameters of diastolic function and left atrial reservoir strain in patients with severe aortic stenosis?
Observational (n=70)
Does transcatheter aortic valve implantation (TAVI) improve echocardiographic parameters of diastolic function and left atrial reservoir strain in patients with severe aortic stenosis?
At 14 months post-TAVI, patients show significant structural reverse remodeling (reduced LAVi and LV-EDV) and increased A-wave velocity, but left atrial reservoir strain does not significantly change or add incremental value for assessing diastolic function.
Background Transcatheter aortic valve implantation (TAVI) is an established treatment for severe, symptomatic aortic stenosis, often used in older patients and those at increased surgical risk. Assessment of left ventricular (LV) diastolic function in this population is challenging, and available data on diastolic changes following TAVI remain inconsistent. Purpose To investigate changes in diastolic function over time after TAVI according to the 2025 American Society of Echocardiography (ASE) guidelines and to determine whether left atrial reservoir strain (LASr) a newly recommended parameter, provides incremental diagnostic value. Methods Diastolic function was assessed using transthoracic echocardiography (TTE) before and at follow-up after TAVI in 109 consecutive patients treated between 2019 and 2021. Patients with atrial fibrillation (AF) were excluded. All TTE measurements were performed on retrospectively stored image datasets by a single experienced operator in accordance with the 2025 ASE guidelines. The following diastolic parameters were analysed: E- and A-wave velocities, medial e’ velocity, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVi), and LASr. LV ejection fraction (LV-EF) and global longitudinal strain (GLS) were also assessed. Changes between baseline and follow-up were analyzed using the paired t-test or Wilcoxon signed-rank test, as appropriate. Results Of the 109 included patients, 70 (64%) were included in the final analysis after exclusions due to atrial fibrillation, missing data, or death prior to follow-up. Median age was 80 years (interquartile range 77-85), and 49% were women. Pre-procedural TTE was performed a median of 164 (118-218) days before TAVI, and follow-up TTE at 423 (382-463) days after the procedure. LAVi decreased significantly after TAVI (41 mL/m2 vs. 37 mL/m2, p = 0.003). LASr was reduced at baseline and showed a non-significant increase at follow-up (18.8% vs. 20.5%, p = 0.22). Conventional diastolic parameters - including E/A ratio (0.75 vs. 0.69, p = 0.27), TR velocity (2.7 m/s vs. 2.5 m/s, p = 0.63), and E/e´ ratio (16.0 vs. 15.7, p = 0.59) - remained largely unchanged, although A-wave velocity increased significantly (102 cm/s vs. 109 cm/s, p = 0.0008). LV end-diastolic volume (LV-EDV) decreased significantly (95 mL vs. 87 mL, p = 0.008). LV-EF and GLS remained unchanged in the overall cohort. Conclusion At 14 months after TAVI, patients demonstrated significant structural reverse remodeling, reflected by reductions in LAVi and LV-EDV, as well as improved late diastolic filling evidenced by increased A-wave velocity. However, LASr showed only a non-significant increase and did not provide incremental value in the assessment of diastolic function in this cohort.
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Eerola et al. (2026) conducted an observational in Severe, symptomatic aortic stenosis treated with TAVI (n=70). Transcatheter aortic valve implantation (TAVI) vs. Pre-procedural baseline was evaluated on Left atrial reservoir strain (LASr) (p=0.22). TAVI significantly reduced LAVi (41 to 37 mL/m2, p=0.003) and increased A-wave velocity (102 to 109 cm/s, p=0.0008), while LASr did not change significantly (18.8% vs 20.5%, p=0.22).
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