The effects of transcatheter aortic valve replacement and conventional aortic valve replacement on cardiac mechanics and function in patients with confirmed severe aortic stenosis. Insights from a national echocardiographic core lab

Aortic Stenosis (AS) is a progressive disease characterised by increasing aortic valve calcification and thickening, leading to escalating left ventricular afterload, and myocardial damage. This sub-study of the UK TAVI trial investigated myocardial functional recovery post-intervention in subjects with severe AS and intermediate surgical risk, randomised to surgical aortic valve replacement (AVR) or transcatheter aortic valve insertion (TAVI). Speckle tracking echocardiography (STE) was used to assess the deformation of the myocardial wall (strain) in trans-thoracic echocardiographic images (TTE’s). Strain was measured pre-intervention (baseline), 6weeks post-intervention(6W), and 12-months post-intervention (12M) in the left ventricle (LV, n≤142), right ventricle (RV, n=25) and left atrium (LA, n=74). Additionally, strain-volume loops were constructed to explore how the haemodynamic relationship between volume and longitudinal strain in the LV changed pre- to post-intervention after AVR and TAVI (n=48). The improvement seen from baseline to 12M in TAVI was non-inferior AVR (P