PURPOSE: Left ventricular myocardial work (LVMW) has been shown to better characterize LV function in patients with severe aortic stenosis by correcting LV afterload. The aim of this study was to evaluate the evolution in LVMW indices after transcatheter aortic valve replacement (TAVR) and their prognostic value. METHODS: The following LVMW indices were calculated before and immediately after TAVR in 255 patients (median age 82 years, 51% male): global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The study endpoint was all-cause mortality. RESULTS: After TAVR, LV ejection fraction and LV global longitudinal strain (GLS) did not change significantly (from 56% to 55%, p = 0.470 and from 13.6% to 13.2%, p = 0.068). Concerning LVMW indices, while LV GWW remained unchanged after TAVR (from 247 to 258 mmHg%, p = 0.080), LV GWI, LV GCW, and LV GWE significantly decreased (from 1882 to 1291 mmHg%, p < 0.001, from 2248 to 1671 mmHg%, p < 0.001, and from 89% to 85%, p < 0.001, respectively). During a median follow-up of 59 [40-72] months, 129 patients died. After correcting for potential confounders (sex, diabetes, renal function, atrial fibrillation, Charlson comorbidity index, and pacemaker implantation post-TAVR), post-TAVR LV GLS, GWI, and GCW remained independently associated with all-cause mortality. However, post-TAVR LV GWI demonstrated the highest increase in model predictivity. CONCLUSION: In patients undergoing TAVR, LVMW parameters significantly change after intervention. LV GWI after TAVR showed the strongest association with all-cause mortality among both conventional and advanced parameters of LV systolic function both pre- and post-TAVR and might enable better risk stratification of these patients after intervention.

Cardiocenter 3rd Faculty of Medicine of Charles University and University Hospital Vinohrady Prague Czech Republic

Department of Cardiology Leiden University Medical Center Leiden The Netherlands

Department of Cardiology San Giovanni Battista Hospital Foligno Italy

Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands

Netherlands Heart Institute Utrecht The Netherlands

School of Medicine University of Western Australia Perth Western Australia Australia

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A. N. Rassi, P. Pibarot, and S. Elmariah, “Left Ventricular Remodelling in Aortic Stenosis,” Canadian Journal of Cardiology 30, no. 9 (2014): 1004–1011.

A. Vahanian, F. Beyersdorf, F. Praz, et al., “2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease,” European Heart Journal 43, no. 7 (2022): 561–632.

J. Magne, B. Cosyns, B. A. Popescu, et al., “Distribution and Prognostic Significance of Left Ventricular Global Longitudinal Strain in Asymptomatic Significant Aortic Stenosis: An Individual Participant Data Meta‐Analysis,” JACC: Cardiovascular Imaging 12, no. 1 (2019): 84–92.

F. Fortuni, J. J. Bax, and V. Delgado, “Changing the Paradigm in the Management of Valvular Heart Disease: In Addition to Left Ventricular Ejection Fraction, Focus on the Myocardium,” Circulation 143, no. 3 (2021): 209–211.

F. Fortuni, S. C. Butcher, F. van der Kley, et al., “Left Ventricular Myocardial Work in Patients With Severe Aortic Stenosis,” Journal of the American Society of Echocardiography 34, no. 3 (2021): 257–266.

R. Jain, T. Bajwa, S. Roemer, et al., “Myocardial Work Assessment in Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement,” European Heart Journal ‐ Cardiovascular Imaging 22, no. 6 (2021): 715–721.

S. De Rosa, J. Sabatino, A. Strangio, et al., “Non‐Invasive Myocardial Work in Patients With Severe Aortic Stenosis,” Journal of Clinical Medicine 11, no. 3 (2022): 747.

H. W. Wu, F. Fortuni, S. C. Butcher, et al., “Prognostic Value of Left Ventricular Myocardial Work Indices in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement,” European Heart Journal ‐ Cardiovascular Imaging 24, no. 12 (2023): 1682–1689.

D. Franco, A. Santoro, G. D. Gioia, et al., “Assessing the Impact of Transcatheter Aortic Valve Replacement on Myocardial Work Indices and Left Ventricular Diastolic Function in Aortic Valve Stenosis Patients,” Echocardiography 40, no. 8 (2023): 768–774.

L. Quinio, M. Taconne, V. Le Rolle, et al., “Evolution of Non‐invasive Myocardial Work Variables After Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis,” Archives of Cardiovascular Diseases 116, no. 4 (2023): 192–201.

H. Baumgartner, J. Hung, J. Bermejo, et al., “Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice,” Journal of the American Society of Echocardiography 22, no. 1 (2009): 1–23. quiz 101–2.

R. M. Lang, L. P. Badano, V. Mor‐Avi, et al., “Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update From the American Society of Echocardiography and the European Association of Cardiovascular Imaging,” Journal of the American Society of Echocardiography 28, no. 1 (2015): 1–39.e14.

L. G. Rudski, W. W. Lai, J. Afilalo, et al., “Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report From the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a Registered Branch of the European Society of Cardiology, and the Canadian Society of Echocardiography,” Journal of the American Society of Echocardiography 23, no. 7 (2010): 685–713. quiz 86–8.

R. Manganaro, S. Marchetta, R. Dulgheru, et al., “Echocardiographic Reference Ranges for Normal Non‐Invasive Myocardial Work Indices: Results From the EACVI NORRE Study,” European Heart Journal ‐ Cardiovascular Imaging 20, no. 5 (2019): 582–590.

F. Ilardi, A. Postolache, R. Dulgheru, et al., “Prognostic Value of Non‐Invasive Global Myocardial Work in Asymptomatic Aortic Stenosis,” Journal of Clinical Medicine 11, no. 6 (2022): 1555.

S. Kwak, R. J. Everett, T. A. Treibel, et al., “Markers of Myocardial Damage Predict Mortality in Patients With Aortic Stenosis,” Journal of the American College of Cardiology 78, no. 6 (2021): 545–558.

O. F. AbouEzzeddine, B. J. Kemp, B. A. Borlaug, et al., “Myocardial Energetics in Heart Failure with Preserved Ejection Fraction,” Circulation: Heart Failure 12, no. 10 (2019): e006240.

K. B. Hansen, J. Sörensen, N. H. Hansson, et al., “Myocardial Efficiency in Patients With Different Aetiologies and Stages of Heart Failure,” European Heart Journal ‐ Cardiovascular Imaging 23, no. 3 (2022): 328–337.

F. Myon, B. Marut, W. Kosmala, et al., “Transcatheter aortic valve implantation in severe aortic stenosis does not necessarily reverse left ventricular myocardial damage: data of long‐term follow‐up,” European Heart Journal ‐ Cardiovascular Imaging 25, no. 6 (2024): 821–828.