Early changes in e' after TAVI reflect not only intrinsic improvement in LV relaxation but also load-related mechanisms during early diastolic filling, as changes in E velocity were independently associated with changes in mean e' even after adjustment for changes in stroke volume.
Key Findings
Results
TAVI significantly increased septal, lateral, and mean mitral annular early diastolic velocity (e') within one week of the procedure.
Retrospective analysis of 129 consecutive patients with severe aortic stenosis who underwent successful TAVI
Echocardiographic evaluation was performed before and within one week after the procedure
Septal, lateral, and mean e' all showed statistically significant increases post-TAVI
TAVI also significantly increased transmitral early diastolic (E) velocity and LV ejection fraction (LVEF) while reducing the transvalvular pressure gradient
Results
Baseline mean e' was the strongest independent predictor of changes in mean e' following TAVI.
In multivariate linear regression analysis, baseline mean e' was independently associated with changes in mean e' (β = -0.590, p < 0.001)
The negative beta coefficient indicates that patients with lower baseline e' experienced greater increases post-TAVI
Covariates in the model included changes in LVEF, E velocity, mean transvalvular pressure gradient, stroke volume, baseline mean e', and atrial fibrillation
Results
Atrial fibrillation was independently associated with greater changes in mean e' following TAVI.
Atrial fibrillation was independently associated with changes in mean e' (β = 0.523, p = 0.006)
This association persisted after adjustment for changes in LVEF, E velocity, mean transvalvular pressure gradient, stroke volume, and baseline mean e'
The positive beta coefficient suggests patients with atrial fibrillation had larger increases in e' post-TAVI
Results
Changes in transmitral early diastolic (E) velocity were independently associated with changes in mean e' after TAVI, even after adjustment for stroke volume changes.
Changes in E velocity were independently associated with changes in mean e' (β = 0.019, p = 0.018)
This association persisted after adjustment for changes in stroke volume, suggesting a load-dependent mechanism beyond simple forward flow increases
The authors interpreted this finding as evidence that early changes in e' reflect not only intrinsic improvement in LV relaxation but also load-related mechanisms during early diastolic filling
Changes in LVEF and mean transvalvular pressure gradient were also included as covariates but were not reported as independently significant
Discussion
The early post-TAVI increase in e' appears to reflect both intrinsic improvement in LV relaxation and load-related hemodynamic mechanisms during early diastolic filling.
The independent association of E velocity changes with e' changes suggests a load-dependent component to the e' increase
The adjustment for stroke volume changes in the multivariate model was intended to isolate the effect of early diastolic filling dynamics from overall forward flow
The study was designed specifically to determine whether e' increases reflected intrinsic LV relaxation improvement or altered hemodynamic conditions
The rapid timeline of change (within one week) was noted as relevant to interpreting the physiological mechanism
What This Means
This research studied what happens to heart function in the first week after patients with severe aortic valve narrowing (aortic stenosis) receive a transcatheter aortic valve implantation (TAVI), a minimally invasive procedure to replace the diseased valve. The study focused on a specific echocardiogram measurement called e', which reflects how well the heart relaxes during its filling phase and is commonly used to assess diastolic (filling) function. In 129 patients, the researchers found that e' improved rapidly after TAVI, alongside improvements in how forcefully the heart pumps and how much blood flows through the valve early in the filling phase.
The key question the researchers asked was: does e' improve after TAVI because the heart muscle itself is relaxing better, or simply because changing blood flow conditions are affecting the measurement? Using statistical modeling, they found that the increase in early blood flow across the mitral valve (called E velocity) was independently linked to the improvement in e', even after accounting for the overall increase in how much blood the heart pumps per beat. This suggests that some of the early improvement in e' is driven by altered filling conditions — meaning the measurement may be partly reflecting hemodynamic (blood flow) changes rather than purely improved heart muscle relaxation.
This research suggests that clinicians interpreting echocardiogram results shortly after TAVI should be cautious about concluding that an improved e' measurement necessarily means the heart muscle is intrinsically relaxing better. Some of the improvement may be a consequence of the changed blood flow environment created by the new valve, rather than a direct improvement in the heart's own relaxation properties. This distinction matters for accurately assessing a patient's recovery and true cardiac function after the procedure.
Ito T, Akamatsu K, Fujioka S, Kinoshita K, Yamauchi Y, Shishikura D, et al.. (2026). Early Enhancement of Mitral Annular e' Following Transcatheter Aortic Valve Implantation: The Role of Early Diastolic Filling.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70619