Changes in diastolic function after TAVI: trends in conventional parameters and the role of left atrial reservoir strain

Background

Transcatheter aortic valve implantation (TAVI) is an established treatment for severe, symptomatic aortic stenosis, often used in older patients and those at increased surgical risk. Assessment of left ventricular (LV) diastolic function in this population is challenging, and available data on diastolic changes following TAVI remain inconsistent.

Purpose

To investigate changes in diastolic function over time after TAVI according to the 2025 American Society of Echocardiography (ASE) guidelines and to determine whether left atrial reservoir strain (LASr) a newly recommended parameter, provides incremental diagnostic value.

Methods

Diastolic function was assessed using transthoracic echocardiography (TTE) before and at follow-up after TAVI in 109 consecutive patients treated between 2019 and 2021. Patients with atrial fibrillation (AF) were excluded. All TTE measurements were performed on retrospectively stored image datasets by a single experienced operator in accordance with the 2025 ASE guidelines. The following diastolic parameters were analysed: E- and A-wave velocities, medial e’ velocity, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVi), and LASr. LV ejection fraction (LV-EF) and global longitudinal strain (GLS) were also assessed. Changes between baseline and follow-up were analyzed using the paired t-test or Wilcoxon signed-rank test, as appropriate.

Results

Of the 109 included patients, 70 (64%) were included in the final analysis after exclusions due to atrial fibrillation, missing data, or death prior to follow-up. Median age was 80 years (interquartile range 77-85), and 49% were women. Pre-procedural TTE was performed a median of 164 (118-218) days before TAVI, and follow-up TTE at 423 (382-463) days after the procedure.

LAVi decreased significantly after TAVI (41 mL/m2 vs. 37 mL/m2, p = 0.003). LASr was reduced at baseline and showed a non-significant increase at follow-up (18.8% vs. 20.5%, p = 0.22). Conventional diastolic parameters - including E/A ratio (0.75 vs. 0.69, p = 0.27), TR velocity (2.7 m/s vs. 2.5 m/s, p = 0.63), and E/e´ ratio (16.0 vs. 15.7, p = 0.59) - remained largely unchanged, although A-wave velocity increased significantly (102 cm/s vs. 109 cm/s, p = 0.0008).

LV end-diastolic volume (LV-EDV) decreased significantly (95 mL vs. 87 mL, p = 0.008). LV-EF and GLS remained unchanged in the overall cohort.

Conclusion

At 14 months after TAVI, patients demonstrated significant structural reverse remodeling, reflected by reductions in LAVi and LV-EDV, as well as improved late diastolic filling evidenced by increased A-wave velocity. However, LASr showed only a non-significant increase and did not provide incremental value in the assessment of diastolic function in this cohort.Graphical Abstract