Wiley Open Access, Journal of the American Heart Association, 2(5), 2016
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Background The aim of this study was to compare left ventricular ( LV ) remodeling using myocardial strain between patients with severe aortic stenosis ( AS ) treated with transcatheter aortic valve replacement ( TAVR ) with and without prosthesis‐patient mismatch ( PPM ). Methods and Results In a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain ( GLS ) and strain rate ( GLSR ), circumferential strain, and rotation before and at mid‐term follow‐up post‐ TAVR . Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm 2 /m 2 , respectively. A total of 102 patients (median age, 83 years [77–88]) with severe AS were included. At 6±3 months post‐ TAVR , moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m 2 ; P =0.001) at follow‐up whereas those with PPM did not. There was a significant improvement in LV GLS (−12.8±4.0 to −14.3±4.3%; P =0.01), GLSR (−0.61±0.20 to −0.73±0.25 second −1 ; P <0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second −1 ; P <0.001) in patients without PPM , but not in those with PPM . After adjustment for pre‐ TAVR ejection fraction and post‐ TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM . After a median follow‐up of 46.1 months (interquartile range, 35.4–60.8), there was no difference in survival between patients with and without PPM . Conclusions TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM . Presence of PPM was not associated with mortality.