Ventricular Mechanics and Serum Biomarkers as Predictors of Aortic Valve Replacement in Severe Aortic Stenosis.

Purpose: Severe aortic stenosis (SAS) requires timely intervention to prevent irreversible myocardial damage. This study evaluated echocardiographic strain parameters and serum biomarkers in SAS patients and explored their value for qualifying patients for aortic valve replacement (AVR). Patients and Methods: A total of 102 patients scheduled for surgical AVR were enrolled (symptomatic: n = 58; asymptomatic: n = 44). Echocardiography was used to measure left ventricular global longitudinal strain (LV GLS), peak atrial longitudinal strain (PALS), and left ventricular mass index (LVMI). Serum levels of osteoprotegerin (OPG), receptor activator of nuclear factor kappa B ligand (RANKL), and TNF-related apoptosis-inducing ligand (TRAIL) were assessed. Follow-up occurred six months postoperatively. Statistical analyses included Mann–Whitney U, Friedman ANOVA with post hoc testing, and logistic regression (p < 0.05). Results: Symptomatic patients showed lower LV GLS (−15.2% vs −16.8%, p = 0.016) and PALS (21.8% vs 27.9%, p < 0.001) before surgery. Six months post-AVR, PALS (24.7% vs 28.6%, p = 0.03) and LVMI (108.1 vs 95.5 g/m 2 , p < 0.001) remained worse in symptomatic patients. OPG levels were higher in SAS patients than in controls (6.90 vs 5.90 pmol/L, p = 0.004) but similar between symptomatic and asymptomatic subgroups. Conclusion: LV GLS, PALS, and OPG levels are useful markers of myocardial dysfunction in SAS. Their persistence after AVR indicates ongoing structural remodeling and supports their use in preoperative evaluation beyond symptom-based assessment.