Left Atrial Functional Improvement Precedes Volumetric Reverse Remodeling After Transcatheter Aortic Valve Implantation: A Speckle- Tracking Echocardiographic Study

Background The temporal sequence of left atrial (LA) functional and structural remodeling after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) remains inadequately characterized. We aimed to evaluate the mid-term changes in LA mechanics and volume using speckle-tracking echocardiography (STE). Methods In this prospective observational study, 162 patients with severe AS undergoing TAVI were enrolled. Echocardiography was performed at baseline, 1, 6, and 12 months post-procedure. LA reservoir strain (LASr), conduit strain (LAScd), and pump strain (LASct) were measured by STE. LA volumes and the LA volume index (LAVI) were also assessed. Results LA strain parameters improved earlier than volumetric parameters. LASr, LAScd, and LASct increased significantly at 1 month post-TAVI (all P  < 0.05) and continued to improve through 12 months. In contrast, LAVI decreased significantly at 1 month ( P  < 0.05), while LA maximum and minimum volumes showed significant reduction only at 6 months post-TAVI ( P  < 0.05). Conclusions LA functional improvement, assessed by STE, precedes volumetric reverse remodeling during mid-term follow-up after TAVI. STE-derived LA strain may serve as a sensitive early marker for monitoring cardiac adaptation post-TAVI.