Myocardial Deformation & Remodeling Following Transcatheter Aortic Valve Implantation in Severe Aortic Stenosis: A Narrative Review

Abstract

Chronic pressure overload due to severe aortic stenosis is also linked to myocardial remodeling that usually inhibits identifying the changes in the conventional systolic indices. Transcatheter aortic valve implantation (TAVI) has also changed the way of trying to treat severe cases of aortic stenosis, successfully reducing afterload and reverse ventricular remodelling. Nevertheless, the conventional echocardiographic measures, especially left ventricular ejection fraction has its limitations in detecting subclinical myocardial dysfunction and also in precise monitoring of myocardial recovery after the intervention. Two-dimensional speckle tracking echocardiography (2D-STE) has become a sensitive and reproducible imaging mode that can be used to quantitatively assess myocardial deformation to provide detailed longitudinal, circumferential, and radial myocardial mechanics. This is a review of the current evidence published between 2020 and 2025 on patterns of myocardial deformation before and after TAVI with particular attention to global longitudinal strain as an indicator of early dysfunction, therapeutic response and prognosis. The review defines the presence of immediate, mid-term, and long-term myocardial remodeling after TAVI and explores an important role of strain-based parameters as prognostic indicators and a comparison of 2D-STE and other imaging modalities. Also, the existing gaps in the research are mentioned, such as the absence of standardized strain cut-offs and lack of long-term data. On the whole, 2D-STE can be discussed as an effective instrument of holistic assessment of the myocardium and individual risk stratification of patients undergoing TAVI.