Preoperative global longitudinal strain predicts myocardial hypertrophy burden but not the magnitude of reverse remodeling after surgical aortic valve replacement in severe aortic stenosis

BACKGROUND: Global longitudinal strain (GLS) is a marker of subclinical myocardial dysfunction and predicts adverse outcomes in severe aortic stenosis. However, its ability to predict the magnitude of left ventricular (LV) reverse remodeling following surgical aortic valve replacement (SAVR) remains uncertain. METHODS: In 94 patients with severe aortic stenosis and preserved ejection fraction undergoing SAVR, patients were stratified by baseline GLS (normal, < -16%; abnormal, ≥ -16%). Given incomplete follow-up, the principal analysis was a complete-case comparison of interventricular septal dimension (IVSd), LV mass index (LVMI), relative wall thickness, and ejection fraction across baseline, post-SAVR, and follow-up in 54 patients with complete data, supplemented by correlation analyses treating baseline GLS as a continuous variable. A mixed-effects model in all 94 patients was a secondary analysis. RESULTS: In the complete-case cohort, the abnormal GLS group had greater IVSd and LVMI and lower ejection fraction at baseline, with these differences persisting at each time point. A significant GLS-by-time interaction was observed for LVMI (P = 0.005). Continuous GLS correlated with absolute LVMI and IVSd at all time points but not with the magnitude of change in any index. After adjustment for baseline disease severity, continuous GLS was not independently associated with any remodeling outcome (all P ≥ 0.121). Baseline GLS identified a greater myocardial hypertrophy burden but does not predict the magnitude of reverse remodeling after SAVR. CONCLUSIONS: Preoperative GLS reflects the severity of preexisting LV hypertrophy but, with the possible exception of LV mass regression, does not independently predict the magnitude of early reverse remodeling after SAVR once baseline disease severity is accounted for.