Strain Evaluation in TAVR—Current Evidence, Knowledge Gaps, and Future Directions

Abstract

Transcatheter aortic valve replacement (TAVR) has been a paradigm shift for the treatment of patients with severe aortic stenosis (AS). Subclinical cardiac changes in myocardial deformation, not reflected by left ventricular ejection fraction (LVEF), are often present and can be measured by strain imaging. This manuscript will review the current literature and discuss the importance of strain evaluation in TAVR patients. Strain measurement, especially global longitudinal strain (GLS), has been shown to be associated with outcomes in patients with AS. In addition, GLS assessment prior to and after TAVR appears to correlate with LV functional recovery, symptoms, and the prognosis in these patients; however, evidence is limited to small studies. With a better understanding of strain evaluation in TAVR patients, this important imaging modality could emerge as a powerful bedside tool to aid in determining the timing of intervention and further improving outcomes.