Clinical and morphological aspects of post-interventional left ventricular remodeling in patients with aortic stenosis undergoing transcatheter implantation or open aortic valve replacement: a review of current literature (2021–2026)
Abstract
Calcific aortic valve stenosis and atherosclerotic coronary artery disease not only share common risk factors but also exert synergistic effects on the left ventricular (LV) myocardium. Hemodynamically significant coronary artery disease is detected in 60–70 % of patients with severe aortic stenosis, and concomitant LV hypertrophy, by increasing myocardial susceptibility to ischemia, accelerates the development of subendocardial replacement fibrosis—an independent predictor of adverse prognosis after valve replacement. This review presents an analysis of current evidence on structural and functional LV remodeling in patients with severe aortic stenosis following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Data on the population prevalence of aortic stenosis are systematized, and the mechanisms of myocardial morphofunctional remodeling are detailed, with a central focus on myocyte hypertrophy, interstitial fibrosis, and neurohormonal dysregulation. The dynamics of LV reverse structural remodeling achieved with the two alternative strategies for correcting aortic stenosis are examined using echocardiography and cardiac magnetic resonance imaging. It is shown that TAVI is associated with earlier and more pronounced reverse remodeling within the first 6 months after the intervention, whereas SAVR is characterized by gradual yet sustained improvement in LV morphofunctional parameters. The molecular basis of cardiomyocyte hypertrophy regression and interstitial fibrosis reversal is analyzed in detail, and the correlation between cardiac structural remodeling and clinical outcomes and long-term prognosis is discussed. The review also systematizes findings obtained by national research groups investigating this problem. In parallel, predictors capable of limiting or, conversely, potentiating the completeness of reverse myocardial structural recovery are analyzed. Future research horizons are outlined, with particular emphasis placed on the implementation of proteomic and genomic techniques, which pave the way toward personalized selection of the valve replacement strategy.