Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study

Antoon J.M. van den Enden; Mark M.P. van den Dorpel; Giulio M. Mondellini; Antonio M. Mattace-Raso; Rik Adrichem; Marcello B. Bastos; Jan J. Schreuder; Mattie J. Lenzen; Isabella Kardys; Marcel L. Geleijnse; Rutger J. Nuis; Joost Daemen; Daniel Burkhoff; Nicolas M. Van Mieghem

doi:10.1016/j.ahj.2025.107302

Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study

^*Corresponding author for this work

Cardiology

Cardiovascular Research Foundation

Research output: Contribution to journal › Article › Academic › peer-review

10 Downloads (Pure)

Abstract

Background:

Severe aortic stenosis (AS) induces a disproportional pressure gradient across the aortic valve causing increased left ventricular (LV) afterload. Transcatheter Aortic Valve Replacement (TAVR) aims to immediately alleviate the aortic pressure gradient and thereby changing LV cardiac mechanics. The aim was to describe by in-vivo assessment of LV pressure-volume (PV) relationships how TAVR acutely affects LV cardiac mechanics.

Methods:

In this prospective observational study in patients with severe AS, LV cardiac mechanics were evaluated with an LV conductance catheter before and after TAVR. The effects of transcatheter valve design, pre and postdilatation, use of rapid pacing (≥180 bpm) and LV ejection fraction (EF) were specifically addressed.

Results:

In-vivo LV PV reconstructions were obtained in 61 patients. Stroke work (SW) and pressure volume area (PVA) were significantly lower following TAVR (decrease from median [25th-75th percentile] of 10,935.6 [6877.5-13490.8] to 6,878.0 [4,870.8-8,613.8] mmHg/mL, P < .001 and from 17,831.5 [12,414.9-22,416.8] to 11,024.9 [8364.7-14705.0] mmHg/mL, P < .001, respectively) with stable SW/PVA ratios. Overall, end-systolic and end-diastolic pressures and volumes were significantly lower after TAVR. Arterial Elastance, as an index for LV afterload also decreased (2.66 [2.01-3.87]-1.96 [1.25-2.72] mmHg/mL, P < .001). LV contractility declined as illustrated by a reduction in End-systolic Elastance (2.22 [1.50-3.10]-1.58 [1.08-2.43] mmHg/mL, P < .001). The trends in changing LV cardiac mechanics were similar for balloon- and self-expanding valves and were not affected by pre/post dilatation, rapid pacing or LV EF.

Conclusions:

TAVR for severe AS resulted in immediate LV unloading, lower myocardial metabolic demand and impaired contractility. Trial Registration This observational study was registered at URL: https://www.clinicaltrials.gov with unique identifier: NCT06204783.

Original language	English
Article number	107302
Journal	American Heart Journal
Volume	293
DOIs	https://doi.org/10.1016/j.ahj.2025.107302
Publication status	Published - Mar 2026

Bibliographical note

Publisher Copyright:
© 2025 The Author(s).

Access to Document

10.1016/j.ahj.2025.107302Licence: CC BY

Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis studyFinal published version, 868 KBLicence: CC BY

Cite this

van den Enden, A. J. M., van den Dorpel, M. M. P., Mondellini, G. M., Mattace-Raso, A. M., Adrichem, R., Bastos, M. B., Schreuder, J. J., Lenzen, M. J., Kardys, I., Geleijnse, M. L., Nuis, R. J., Daemen, J., Burkhoff, D., & Van Mieghem, N. M. (2026). Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study. American Heart Journal, 293, Article 107302. https://doi.org/10.1016/j.ahj.2025.107302

@article{c8e9e53104d143909f6ee000d2d678c7,

title = "Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study",

abstract = "Background:Severe aortic stenosis (AS) induces a disproportional pressure gradient across the aortic valve causing increased left ventricular (LV) afterload. Transcatheter Aortic Valve Replacement (TAVR) aims to immediately alleviate the aortic pressure gradient and thereby changing LV cardiac mechanics. The aim was to describe by in-vivo assessment of LV pressure-volume (PV) relationships how TAVR acutely affects LV cardiac mechanics. Methods:In this prospective observational study in patients with severe AS, LV cardiac mechanics were evaluated with an LV conductance catheter before and after TAVR. The effects of transcatheter valve design, pre and postdilatation, use of rapid pacing (≥180 bpm) and LV ejection fraction (EF) were specifically addressed. Results:In-vivo LV PV reconstructions were obtained in 61 patients. Stroke work (SW) and pressure volume area (PVA) were significantly lower following TAVR (decrease from median [25th-75th percentile] of 10,935.6 [6877.5-13490.8] to 6,878.0 [4,870.8-8,613.8] mmHg/mL, P < .001 and from 17,831.5 [12,414.9-22,416.8] to 11,024.9 [8364.7-14705.0] mmHg/mL, P < .001, respectively) with stable SW/PVA ratios. Overall, end-systolic and end-diastolic pressures and volumes were significantly lower after TAVR. Arterial Elastance, as an index for LV afterload also decreased (2.66 [2.01-3.87]-1.96 [1.25-2.72] mmHg/mL, P < .001). LV contractility declined as illustrated by a reduction in End-systolic Elastance (2.22 [1.50-3.10]-1.58 [1.08-2.43] mmHg/mL, P < .001). The trends in changing LV cardiac mechanics were similar for balloon- and self-expanding valves and were not affected by pre/post dilatation, rapid pacing or LV EF. Conclusions:TAVR for severe AS resulted in immediate LV unloading, lower myocardial metabolic demand and impaired contractility. Trial Registration This observational study was registered at URL: https://www.clinicaltrials.gov with unique identifier: NCT06204783.",

author = "\{van den Enden\}, \{Antoon J.M.\} and \{van den Dorpel\}, \{Mark M.P.\} and Mondellini, \{Giulio M.\} and Mattace-Raso, \{Antonio M.\} and Rik Adrichem and Bastos, \{Marcello B.\} and Schreuder, \{Jan J.\} and Lenzen, \{Mattie J.\} and Isabella Kardys and Geleijnse, \{Marcel L.\} and Nuis, \{Rutger J.\} and Joost Daemen and Daniel Burkhoff and \{Van Mieghem\}, \{Nicolas M.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s).",

year = "2026",

month = mar,

doi = "10.1016/j.ahj.2025.107302",

language = "English",

volume = "293",

journal = "American Heart Journal",

issn = "0002-8703",

publisher = "Elsevier Inc.",

}

van den Enden, AJM , van den Dorpel, MMP , Mondellini, GM , Mattace-Raso, AM , Adrichem, R , Bastos, MB, Schreuder, JJ, Lenzen, MJ, Kardys, I , Geleijnse, ML , Nuis, RJ , Daemen, J, Burkhoff, D & Van Mieghem, NM 2026, 'Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study', American Heart Journal, vol. 293, 107302. https://doi.org/10.1016/j.ahj.2025.107302

Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study. / van den Enden, Antoon J.M.; van den Dorpel, Mark M.P.; Mondellini, Giulio M. et al.
In: American Heart Journal, Vol. 293, 107302, 03.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study

AU - van den Enden, Antoon J.M.

AU - van den Dorpel, Mark M.P.

AU - Mondellini, Giulio M.

AU - Mattace-Raso, Antonio M.

AU - Adrichem, Rik

AU - Bastos, Marcello B.

AU - Schreuder, Jan J.

AU - Lenzen, Mattie J.

AU - Kardys, Isabella

AU - Geleijnse, Marcel L.

AU - Nuis, Rutger J.

AU - Daemen, Joost

AU - Burkhoff, Daniel

AU - Van Mieghem, Nicolas M.

PY - 2026/3

Y1 - 2026/3

N2 - Background:Severe aortic stenosis (AS) induces a disproportional pressure gradient across the aortic valve causing increased left ventricular (LV) afterload. Transcatheter Aortic Valve Replacement (TAVR) aims to immediately alleviate the aortic pressure gradient and thereby changing LV cardiac mechanics. The aim was to describe by in-vivo assessment of LV pressure-volume (PV) relationships how TAVR acutely affects LV cardiac mechanics. Methods:In this prospective observational study in patients with severe AS, LV cardiac mechanics were evaluated with an LV conductance catheter before and after TAVR. The effects of transcatheter valve design, pre and postdilatation, use of rapid pacing (≥180 bpm) and LV ejection fraction (EF) were specifically addressed. Results:In-vivo LV PV reconstructions were obtained in 61 patients. Stroke work (SW) and pressure volume area (PVA) were significantly lower following TAVR (decrease from median [25th-75th percentile] of 10,935.6 [6877.5-13490.8] to 6,878.0 [4,870.8-8,613.8] mmHg/mL, P < .001 and from 17,831.5 [12,414.9-22,416.8] to 11,024.9 [8364.7-14705.0] mmHg/mL, P < .001, respectively) with stable SW/PVA ratios. Overall, end-systolic and end-diastolic pressures and volumes were significantly lower after TAVR. Arterial Elastance, as an index for LV afterload also decreased (2.66 [2.01-3.87]-1.96 [1.25-2.72] mmHg/mL, P < .001). LV contractility declined as illustrated by a reduction in End-systolic Elastance (2.22 [1.50-3.10]-1.58 [1.08-2.43] mmHg/mL, P < .001). The trends in changing LV cardiac mechanics were similar for balloon- and self-expanding valves and were not affected by pre/post dilatation, rapid pacing or LV EF. Conclusions:TAVR for severe AS resulted in immediate LV unloading, lower myocardial metabolic demand and impaired contractility. Trial Registration This observational study was registered at URL: https://www.clinicaltrials.gov with unique identifier: NCT06204783.

AB - Background:Severe aortic stenosis (AS) induces a disproportional pressure gradient across the aortic valve causing increased left ventricular (LV) afterload. Transcatheter Aortic Valve Replacement (TAVR) aims to immediately alleviate the aortic pressure gradient and thereby changing LV cardiac mechanics. The aim was to describe by in-vivo assessment of LV pressure-volume (PV) relationships how TAVR acutely affects LV cardiac mechanics. Methods:In this prospective observational study in patients with severe AS, LV cardiac mechanics were evaluated with an LV conductance catheter before and after TAVR. The effects of transcatheter valve design, pre and postdilatation, use of rapid pacing (≥180 bpm) and LV ejection fraction (EF) were specifically addressed. Results:In-vivo LV PV reconstructions were obtained in 61 patients. Stroke work (SW) and pressure volume area (PVA) were significantly lower following TAVR (decrease from median [25th-75th percentile] of 10,935.6 [6877.5-13490.8] to 6,878.0 [4,870.8-8,613.8] mmHg/mL, P < .001 and from 17,831.5 [12,414.9-22,416.8] to 11,024.9 [8364.7-14705.0] mmHg/mL, P < .001, respectively) with stable SW/PVA ratios. Overall, end-systolic and end-diastolic pressures and volumes were significantly lower after TAVR. Arterial Elastance, as an index for LV afterload also decreased (2.66 [2.01-3.87]-1.96 [1.25-2.72] mmHg/mL, P < .001). LV contractility declined as illustrated by a reduction in End-systolic Elastance (2.22 [1.50-3.10]-1.58 [1.08-2.43] mmHg/mL, P < .001). The trends in changing LV cardiac mechanics were similar for balloon- and self-expanding valves and were not affected by pre/post dilatation, rapid pacing or LV EF. Conclusions:TAVR for severe AS resulted in immediate LV unloading, lower myocardial metabolic demand and impaired contractility. Trial Registration This observational study was registered at URL: https://www.clinicaltrials.gov with unique identifier: NCT06204783.

UR - https://www.scopus.com/pages/publications/105023881641

U2 - 10.1016/j.ahj.2025.107302

DO - 10.1016/j.ahj.2025.107302

M3 - Article

C2 - 41241186

AN - SCOPUS:105023881641

SN - 0002-8703

VL - 293

JO - American Heart Journal

JF - American Heart Journal

M1 - 107302

ER -

Immediate changes in left ventricular cardiac mechanics following transcatheter aortic valve replacement for severe aortic stenosis – an in-vivo pressure-volume analysis study

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this