Early reverse remodeling assessed by myocardial work indices and atrial strain following myval transcatheter aortic valve implantation: a prospective single-center study

Transcatheter aortic valve implantation (TAVI) provides afterload relief in patients with severe aortic stenosis (AS). While global longitudinal strain (GLS) is considered a sensitive marker of LV systolic function, myocardial work (MW) indices, which integrate strain and non-invasive LV pressure curves, may provide a more robust measure of myocardial performance.

We aimed to assess early changes in myocardial deformation, left atrial reservoir strain (LARS), and MW indices following TAVI with the Myval balloon-expandable valve, and to evaluate their association with functional improvement.

We prospectively studied 31 consecutive patients with symptomatic severe AS undergoing TAVI with MyVAL. Comprehensive echocardiography, including LV and RV GLS, and LARS, was performed at baseline and 30-day follow-up. MW indices [global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE)] were computed using EchoPAC with non-invasive brachial BP calibration. Clinical status and major adverse cardiac events were assessed at 30 days.

Procedural success was 100%. At 30 days, a ≥1-class NYHA improvement occurred in 97% of patients. Aortic valve mean gradient decreased significantly (Δ−32.8 mmHg, p<0.001). When assessing myocardial deformation, LV GLS paradoxically became less negative following TAVI, with mean values moving from −14.7±3.7% at baseline to −13.4±3.5% at 30 days (p=0.028). RV global strain remained unchanged (−17.6±5.2% vs. −17.1±5.5%, p=0.46). By contrast, left atrial performance showed a favorable trajectory, with LARS increasing from 20.9±7.5% to 22.9±8.2% (p=0.079),

GWW decreased substantially from 287±118 mmHg% at baseline to 210±93 mmHg% at follow-up (p<0.001), indicating a significant reduction in energy loss due to dyssynchronous or ineffective myocardial contraction. In parallel, GWI improved markedly, rising from 91.0±4.1% to 95.9±3.8% (p<0.001), reflecting the more favorable redistribution of energy toward effective ejection. GCW also increased significantly, from 1996±570 mmHg% to 2120±545 mmHg% (p=0.039), suggesting that TAVI enhances the ability of the LV to perform useful systolic work once the afterload burden is alleviated. GWI demonstrated a modest but consistent upward shift, from 2094±534 to 2178±488 mmHg% (p=0.051), a change consistent with improved overall stroke work while accounting for normalized loading conditions. At 30-day follow-up, one death was reported (3%).

In severe AS patients treated with Myval-TAVI, early hemodynamic unloading improved symptoms, myocardial work indices, and atrial strain, while GLS showed only modest change, underscoring MW indices and atrial strain as more sensitive markers of early reverse remodeling and useful tools for post-TAVI follow-up.For image description, please refer to the figure legend and surrounding text.