An exploratory analysis of the EARLY TAVR trial has found that the benefits of early transcatheter aortic valve replacement (TAVR) for asymptomatic severe aortic stenosis (AS) are consistent, regardless of baseline left ventricular (LV) health.¹ This suggests that waiting for LV deterioration may not be the optimal strategy for timing intervention.

Methodology

This analysis used data from the EARLY TAVR trial (NCT03042104), which randomised 901 patients with asymptomatic severe AS at 75 centres to either early TAVR (n=455) or clinical surveillance (CS) (n=446).¹

Using core laboratory echocardiographic measurements, investigators assessed LV health based on a prespecified composite endpoint of three measures: absolute LV global longitudinal strain (GLS) ≥15%, LV mass index (LVMi) <115 g/m² for men or <95 g/m² for women, and left atrial volume index (LAVi) ≤34 mL/m². The analysis examined whether this integrated LV health measure, or its individual components, modified the treatment effect of early TAVR.

Results

At baseline, only 27% of the intention-to-treat population had normal integrated LV health. Abnormal LV health, both as a composite and by its individual components, was generally associated with higher rates of adverse clinical events.¹

The key finding was that the superiority of early TAVR over CS was consistently observed across primary and secondary endpoints, irrespective of whether patients had normal or abnormal LV health at randomisation.

Longitudinal assessment showed that LV health was better preserved in the early intervention group. At 2 years, significantly more patients in the TAVR arm had normal integrated LV health compared to the CS arm (48.1% vs 35.9%; p<0.001). Furthermore, patients in the CS group who eventually underwent delayed aortic valve replacement tended to show a decline in LV health from baseline to the pre-procedural assessment.

Interpretation

These exploratory findings suggest that measures of LV health have limited value for guiding the timing of TAVR in patients with asymptomatic severe AS. The benefit of early intervention appears to extend even to patients with preserved LV function at baseline. The progressive worsening of LV health observed during the clinical surveillance period may contribute to the increased clinical events seen in that treatment arm in the main trial.²

Next Steps

Further study is required to confirm whether the deterioration of LV health associated with a strategy of clinical surveillance and delayed intervention is the direct cause of increased clinical events.

This study was funded by Edwards Lifesciences.

Disclaimer

The information presented in this article is for educational purposes only. Any quotes included reflect the opinions of the individual quoted, and do not necessarily reflect the views of the publisher. The publisher does not guarantee the accuracy or completeness of the content and accepts no responsibility for any errors, or any consequences arising from its use.

References

1. Lindman BR, Pibarot P, Schwartz A, et al. Left Ventricular Health and TAVR Timing in Asymptomatic Severe Aortic Stenosis: Analysis From the EARLY TAVR Trial. JACC. 2026;87(4):339-358. https://doi.org/10.1016/j.jacc.2025.08.071

2. Genereux P, Schwartz A, Oldemeyer JB, et al. Transcatheter aortic-valve replacement for asymptomatic severe aortic stenosis. N Engl J Med. 2025;392:217-227. https://doi.org/10.1056/NEJMoa2405880