Evolution and prognostic impact of left ventricular myocardial work indices after transcatheter aortic valve replacement in patients with severe aortic stenosis

Abstract

Purpose: Left ventricular myocardial work (LVMW) has been shown to better characterize LV function in patients with severeaortic stenosis by correcting LV afterload. The aim of this study was to evaluate the evolution in LVMW indices after transcatheteraortic valve replacement (TAVR) and their prognostic value.Methods: The following LVMW indices were calculated before and immediately after TAVR in 255 patients (median age 82 years,51% male): global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency(GWE). The study endpoint was all-cause mortality.Results: After TAVR, LV ejection fraction and LV global longitudinal strain (GLS) did not change significantly (from 56% to 55%,p = 0.470 and from 13.6% to 13.2%, p = 0.068). Concerning LVMW indices, while LV GWW remained unchanged after TAVR (from247 to 258 mmHg%, p = 0.080), LV GWI, LV GCW, and LV GWE significantly decreased (from 1882 to 1291 mmHg%, p < 0.001, from2248 to 1671 mmHg%, p < 0.001, and from 89% to 85%, p < 0.001, respectively). During a median follow-up of 59 [40–72] months,129 patients died. After correcting for potential confounders (sex, diabetes, renal function, atrial fibrillation, Charlson comorbidityindex, and pacemaker implantation post-TAVR), post-TAVR LV GLS, GWI, and GCW remained independently associated withall-cause mortality. However, post-TAVR LV GWI demonstrated the highest increase in model predictivity.Conclusion: In patients undergoing TAVR, LVMW parameters significantly change after intervention. LV GWI after TAVRshowed the strongest association with all-cause mortality among both conventional and advanced parameters of LV systolicfunction both pre- and post-TAVR and might enable better risk stratification of these patients after intervention.