Early Changes in Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) improves left ventricular (LV) deformation by aortic stenosis (AS). However, the early effects of TAVR on LV mechanics as assessed by echocardiography have not been fully elucidated.

Methods and results: Between 2021 and 2024, we included 81 patients who underwent transfemoral TAVR for severe AS. We used the natural logarithm of B-type natriuretic peptide (lnBNP) 1 week after TAVR as an indicator of the early effects on LV mechanics. To determine the association with echocardiographic parameters (LV ejection fraction [LVEF], global longitudinal strain [GLS], E/e', and Tei index) and postprocedural lnBNP, we used regression models while adjusting for covariates. There were no significant differences in LVEF, GLS or E/e' between before and after TAVR, but the postprocedural Tei index was significantly higher than the preprocedural Tei index (0.40 vs. 0.26, P<0.01). In a univariate linear regression, the preprocedural LVEF (β=-0.28, P=0.01), GLS (β=-0.24, P=0.04), E/e' (β=0.36, P<0.01), and Tei index (β=0.27, P=0.02) correlated with postprocedural lnBNP. Regarding the postprocedural parameters, GLS (β=-0.27, P=0.02) and E/e' (β=0.36, P<0.01) also correlated with postprocedural lnBNP, but the LVEF and Tei index did not. After adjustment for covariates, these correlations remained significant.

Conclusions: Preprocedural echocardiographic parameters reflecting LV function correlated with BNP after TAVR, but the utility of postprocedural parameters may depend on preprocedural LV function or perioperative factors.