Assessment of reverse remodeling after transcatheter aortic valve replacement in the presence of established right ventricular damage

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Abstract Background Right ventricular (RV) damage in patients with severe aortic stenosis (AS) is associated with worse prognosis and higher rates of adverse clinical events following transcatheter aortic valve replacement (TAVR). However, it remains unclear whether these patients experience significant reverse remodeling after the procedure. This study aimed to evaluate the degree of reverse remodeling one-year post-TAVR in patients with and without baseline RV damage. Methods We conducted a retrospective analysis of a prospective cohort of patients who underwent TAVR at a tertiary hospital between 2017 and 2023. Baseline and 1-year follow-up echocardiographic parameters were collected to assess reverse remodeling. RV damage was defined as right ventricle-arterial (RV-AP) coupling <0.35 at baseline. Results A total of 667 patients were analyzed (mean age: 82.3 ± 5.8 years; 53.7% female; mean EuroSCORE II: 5.3 ± 6). Baseline RV damage was present in 103 patients (15.4%). Compared to those without RV impairment, patients with RV damage had worse left ventricular (LV) function, larger left atrial (LA) volumes, and more frequent concomitant mitral (MR) and tricuspid regurgitation (TR). Despite this, they demonstrated significant improvements in left ventricular ejection fraction (LVEF), left ventricular mass index (LVMi), and right-sided echocardiographic parameters, including tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and RV-APc. However, MR and TR severity remained largely unchanged. At follow-up, even in the presence of reverse remodeling, patients with baseline RV damage had significantly higher rates of heart failure (HF) hospitalization (HR: 2.54, 95% CI: 1.63–3.98) and all-cause mortality (HR: 1.71, 95% CI: 1.19–2.48). Conclusions Approximately 15% of patients undergoing TAVR exhibited pre-existing RV damage. While these patients demonstrated some degree of reverse remodeling and RV function improvement, they did not fully normalize and remained at higher risk for cardiovascular events. These results underscore the importance of early intervention, possibly before RV damage occurs, to optimize long-term outcomes. Closer follow-up of this high-risk subgroup is warranted. ABBREVIATIONS: LV end-diastolic volume index (LVEDVi); Left ventricular global longitudinal strain (LV-GLS); Right ventricular global longitudinal strain (RV-GLS); Left atrial volume index (LAVi); Global longitudinal left atrial strain during the reservoir phase (LASr); Stroke volume index (Svi)Figure 1 Figure 2

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