Left and right heart remodeling at 1 year after transcatheter versus surgical aortic valve replacement: A speckle-tracking echocardiography study

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ID: 317386
2026
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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.
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Authors Olga N. Kislitsina, S Chris Malaisrie, James D Thomas, An Seokyung, Beth Whippo, Jane Kruse, Ranya Sweis, Anita W Asgar, Charles J Davidson, James D. Flaherty, Patrick M McCarthy, Christopher K. Mehta
Journal Interdisciplinary CardioVascular and Thoracic Surgery
Year 2026
DOI
10.1093/icvts/ivag134
URL
https://doi.org/10.1093/icvts/ivag134
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