June 16, 2026Open Access
View Full PaperLeft and right heart remodeling at 1 year after transcatheter versus surgical aortic valve replacement: A speckle-tracking echocardiography study
Key Result
Right ventricular function deteriorated more after SAVR than TAVR (p<0.001), and preoperative left atrial volume index predicted 1-year mortality (OR 1.03; 95% CI 1.02-1.05).
Key Points
- This research compares left and right heart remodeling after transcatheter and surgical aortic valve replacement using speckle-tracking echocardiography.
- Analyzed preoperative and postoperative echocardiographic parameters in 373 patients (TAVR n = 195; SAVR n = 178).
- Used multivariable logistic regression to assess predictors of clinical outcomes at 1 year.
- RV function deteriorated post-SAVR compared to TAVR (p < 0.001).
- LAVI predicted mortality (adjusted OR 1.03, 95% CI 1.02-1.05; p = 0.001) and AF recurrence (OR 1.04; p = 0.001).
- Postoperative LV-GLS was associated with mortality (OR 1.08; p = 0.013) and AF recurrence (OR 1.16; p = 0.001).
Study Design
Type
Cohort (n=373)
Structured PICO
Does TAVR compared to SAVR affect left and right heart remodeling, and do speckle-tracking echocardiography parameters predict 1-year clinical outcomes in patients undergoing aortic valve replacement?
P
Population
373 patients undergoing transcatheter or surgical aortic valve replacement, evaluated with speckle-tracking echocardiography for 1-year clinical outcomes.
E
Exposure
Transcatheter aortic valve replacement (TAVR)
C
Comparator
Surgical aortic valve replacement (SAVR)
O
Outcome
Strain-based remodelling (LAVI, LV-GLS, RV-FWS, RV-GLS, TAPSE) and 1-year clinical outcomes (mortality, AF recurrence, stroke)surrogate
TAVR preserves right ventricular function better than SAVR, and routine echocardiographic strain assessment provides substantial prognostic value for 1-year clinical outcomes after aortic valve replacement.
Main Result
Odds Ratio: 1.03 (95% CI 1.02–1.05)
p-value: p=0.001
Abstract
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.