Key result
Early post-TAVR remodeling independently predicted MACE, including 6-month LVGLS (HR 0.84/unit improvement, p=0.0029), VAC (HR 1.89, p=0.0055), and lack of ≥10% LA volume reduction (HR 2.69, p=0.012).
Why the study?
Clinical outcomes after TAVR remain heterogeneous despite effective relief of valvular obstruction, and the prognostic role of early physiologic recovery and integrated post-procedural remodeling was incompletely defined.
Do early remodeling parameters and temporal changes in myocardial mechanics independently predict major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR)?
Cohort (n=150)
Do early remodeling parameters and temporal changes in myocardial mechanics independently predict major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR)?
Myocardial recovery after TAVR largely plateaus at 6 months, and integrating early physiologic recovery parameters—such as LVGLS, left atrial volume reduction, and ventriculo-arterial coupling—significantly predicts long-term MACE.
Early post-TAVR remodeling parameters were associated with MACE; hypothesis-generating for risk stratification and requires prospective validation.
Background Although transcatheter aortic valve replacement (TAVR) effectively relieves valvular obstruction, clinical outcomes remain heterogeneous. The prognostic role of early physiologic recovery and integrated post-procedural remodeling remains incompletely defined. Objectives To characterize temporal changes in myocardial mechanics after TAVR and determine whether early remodeling parameters independently predict major adverse cardiovascular events (MACE). Methods In 150 patients undergoing TAVR, speckle-tracking echocardiography was performed at baseline and at 3, 6, and 12 months to assess left ventricular global longitudinal strain (LVGLS) and left atrial reservoir strain (LASr). The prognostic cohort with complete clinical and imaging data at 6 months. Ventriculo-arterial coupling (VAC) was calculated non-invasively using echocardiographic volumes as the ratio of end-systolic volume to stroke volume (ESV/SV), reflecting ventricular–vascular interaction. Cox proportional hazards regression models were used to identify independent predictors of MACE, incorporating electrical substrate, residual afterload, myocardial recovery, and atrial reverse remodeling. Results The mean age was 80 ± 5 years, 54% were male, 12% had atrial fibrillation, and 68% had coronary artery disease. During a median follow-up of 3 years, 30 patients experienced MACE. Significant structural reverse remodeling occurred within 6 months, with left atrial volume index decreasing from 48 to 42 mL/m² (p < 0.001) and left ventricular mass index decreasing from 149 to 134 g/m² (p = 0.002). Both atrial and ventricular mechanics improved significantly after TAVR. LASr increased at 3 months (+1.92%, p = 0.031), 6 months (+4.44%, p < 0.001), and 12 months (+2.96%, p = 0.001). LVGLS improved at 3 months (+2.32%, p < 0.001), 6 months (+3.04%, p < 0.001), and 12 months (+3.28%, p < 0.001), with most recovery occurring within 6 months and subsequent plateau. Independent predictors of MACE included atrial fibrillation (HR 3.76, p = 0.0021), higher post-procedural VAC (HR 1.89, p = 0.0055), impaired LVGLS at 6 months (HR 0.84 per unit improvement, p = 0.0029), and absence of ≥10% reduction in left atrial volume (HR 2.69, p = 0.012). Conclusions Myocardial recovery after TAVR follows a time-dependent trajectory characterized by early structural and functional improvement with plateau after six months. Long-term outcomes are determined not only by procedural success but also by early physiologic recovery integrating electrical substrate, ventricular–vascular interaction, myocardial mechanics, and atrial reverse remodeling. Early remodeling parameters may improve post-TAVR risk stratification and guide individualized follow-up strategies.
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Wimolwattanaphan et al. (2026) conducted a cohort in Aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=150). Early physiologic recovery and myocardial remodeling parameters post-TAVR (LVGLS at 6 months) vs. Impaired remodeling / recovery was evaluated on Major adverse cardiovascular events (MACE) (HR 0.84, p=0.0029). Early post-TAVR remodeling independently predicted MACE, including 6-month LVGLS (HR 0.84/unit improvement, p=0.0029), VAC (HR 1.89, p=0.0055), and lack of ≥10% LA volume reduction (HR 2.69, p=0.012).
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