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This editorial refers to ‘Prognostic implications and alterations in left atrial deformation following transcatheter aortic valve implantation’, by S.C. Butcher et al., https://doi.org/10.1093/ehjci/jeae170.

As a minimally invasive alternative to surgical aortic valve replacement, transcatheter aortic valve implantation (TAVI) is particularly suited for severe aortic stenosis (AS) patients at high surgical risk. Intervention is recommended based on symptomatic status or decreasing left ventricular (LV) systolic function. However, LV diastolic dysfunction (DD) often precedes systolic dysfunction and remains an important aspect of AS pathophysiology and symptom burden.1 Chronic LV pressure overload leads to elevated filling pressures, increased intrinsic wall stress and stiffness, hypertrophy, and myocardial fibrosis.2 Only some of these AS-related structural and functional changes are reversible after valve replacement.1 In the era of TAVI, identifying patients at risk might improve clinical outcomes and reduce post-procedural complications through personalized and more aggressive risk factor management.

LV DD and left atrial (LA) function has been shown to be closely correlated due to the close interplay of the two heart chambers during diastole.3 LA function can be divided into three phases: The reservoir function during systole, the conduit function during early diastole, and the booster pump function during late diastole. The LA functional phases can be distinguished and characterized by various methods. One quite promising method is LA strain by 2D speckle tracking echocardiography, and particular LA reservoir strain (LARS; also called peak atrial longitudinal strain) has been highlighted as a useful tool for early detection of LA alterations and a significant prognosticator in various heart diseases4,5 including AS.6

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Editorial
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