Reverse remodeling after aortic valve intervention in patients with aortic stenosis: echocardiographic assessments and prognostic implications.

Aortic stenosis (AS) is the most prevalent valvular heart disease among the elderly, often leading to chronic left ventricular (LV) pressure overload, myocardial hypertrophy, and fibrosis. Following surgical or transcatheter aortic valve replacement (SAVR/TAVI), relief of afterload can induce reverse remodeling - characterized by reductions in LV size, LV mass index (LVMI), improvements in LV ejection fraction (LVEF), global longitudinal strain (GLS), and left atrial (LA) parameters. The extent of reverse remodeling varies significantly among patients and is closely associated with prognosis. Greater regression in LVMI and improvements in LVEF or GLS have been linked to reduced cardiovascular events and mortality. Conversely, persistent LV hypertrophy, lack of LVEF improvement, or impaired GLS recovery are associated with adverse outcomes. Factors influencing reverse remodeling include underlying myocardial conditions such as advanced fibrosis, or comorbidities like hypertension and diabetes, and/or residual hemodynamic burden [ e.g., elevated blood pressure, prosthesis-patient mismatch, residual aortic regurgitation (AR)]. Echocardiographic assessment of LVMI, LVEF, GLS, and LA indices enables clinicians to evaluate reverse remodeling, stratify risk, and guide post-operative management. Emerging evidence suggests GLS and LA strain may provide prognostic information beyond conventional LVEF. Optimizing hemodynamic conditions and considering early intervention before irreversible myocardial damage could help promote reverse remodeling and may improve long-term outcomes. Comprehensive echocardiographic follow-up is essential for identifying patients at higher residual risk and support its role in risk stratification following valve intervention.