Early changes in global longitudinal strain after transcatheter aortic valve replacement
Zamora-Díaz, JJ Ik Yahalcab; Somarriba-Domínguez, Sandra B; Morales-Portano, Julieta D; Gómez-Álvarez, Enrique; Lara-Vargas, Jorge Antonio; García-García, Juan Francisco
ABSTRACT
Introduction: aortic stenosis is a prevalent and progressively worsening valvular heart condition associated with elevated rates of morbidity and mortality. While the left ventricular ejection fraction has traditionally served as the standard parameter for assessing systolic function, global longitudinal strain has gained recognition as a more sensitive marker capable of detecting subclinical myocardial impairment, even in individuals with preserved LVEF. Transcatheter aortic valve replacement offers a minimally invasive alternative to surgical valve replacement, particularly in high-risk patients. The Généreux classification stratifies patients with severe AS into stages based on extra-valvular cardiac involvement to better characterize the extent of myocardial damage. While long-term structural improvements after TAVR have been reported, early functional recovery remains underexplored.
Objective: in this context, we aimed to evaluate early changes in GLS and the E/e' ratio three months after TAVR in patients stratified by the Généreux classification.
Material and methods: a descriptive, observational, and cross-sectional study was conducted at the Centro Médico Nacional 20 de Noviembre. Demographic, echocardiographic, and hemodynamic variables were obtained from institutional electronic medical records. For statistical analysis, the χ2 test or Student's t-test was used, and Spearman's correlation test was applied to evaluate associations between quantitative variables.
Results: our study demonstrated a significant improvement in GLS across all stages, including patients with advanced myocardial involvement. In contrast, no significant changes were observed in the E/e' ratio, suggesting that early GLS improvement may not be directly associated with changes in diastolic filling pressures.
Conclusion: these findings highlight the potential of GLS as an early marker of myocardial recovery following TAVR and support the prognostic value of the Généreux classification in this population.
