Left and Right Heart Remodelling at 1 Year After Transcatheter Versus Surgical Aortic Valve Replacement: A Speckle-Tracking Echocardiography Study.

OBJECTIVES: Speckle-tracking echocardiography (STE) identifies subclinical myocardial dysfunction after aortic valve replacement. We compared strain-based remodelling and prognostic values after transcatheter (TAVR) vs surgical (SAVR) aortic valve replacement.

METHODS: We analysed preoperative (preop) and postoperative (postop) left atrial volume index (LAVI), left ventricular (LV) global longitudinal strain (LV-GLS), right ventricular (RV) free wall strain (RV-FWS), RV global longitudinal strain (RV-GLS), and tricuspid annular plane systolic excursion (TAPSE) in 373 patients (TAVR n = 195; SAVR n = 178). Multivariable logistic regression assessed echocardiographic predictors of 1-year clinical outcomes.

RESULTS: Left ventricular ejection fraction and LV-GLS remained stable in both groups. Right ventricular function deteriorated post-SAVR compared to TAVR (P < .001), with marked declines in TAPSE and RV-GLS (both P < .001). Preop LAVI predicted mortality (adjusted OR, 1.03; 95% CI, 1.02-1.05; P = .001) and atrial fibrillation (AF) recurrence (OR, 1.04; 95% CI, 1.02-1.06; P = .001). Stroke was predicted by preop RV-GLS (OR, 0.91; P = .031) and TAPSE (OR, 1.12; P = .013). Postop LAVI (OR, 1.06; P = .001), RV-FWS (OR, 1.06; P = .016), RV-GLS (OR, 1.10; P = .006), and TAPSE (OR, 0.93; P = .035) also remained significant predictors. Furthermore, postop LV-GLS was associated with mortality (OR, 1.08; P = .013) and AF recurrence (OR, 1.16; P = .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.