Why the study?
Estimation of left ventricular contractility in aortic stenosis is difficult due to load dependency, and no studies had evaluated whether the LVEF to end-systolic wall stress ratio is affected by loading conditions.
Does transcatheter aortic valve replacement alter end-systolic wall stress and ESWS-corrected LVEF in patients with severe aortic stenosis?
Observational (n=41)
Does transcatheter aortic valve replacement alter end-systolic wall stress and ESWS-corrected LVEF in patients with severe aortic stenosis?
ESWS decreases significantly immediately after TAVR, but ESWS-corrected LVEF increases slightly, indicating that this ratio remains load-dependent and may not be a pure marker of contractility.
May not serve as load-independent contractility marker post-TAVR; leaves open its utility pending prospective validation.
Aims In aortic stenosis (AS), estimation of left ventricular (LV) contractility is difficult as most markers of systolic LV function are load-dependent. The ratio of LV ejection fraction (LVEF) to end-systolic wall stress (ESWS), has been widely accepted as a marker of contractility. However, no studies have evaluated if this ratio is affected by loading conditions. The study describes changes in ESWS and ESWS corrected LVEF after transcatheter aortic valve replacement (TAVR). Methods and results In this prospective study, 41 patients with severe AS underwent echocardiography, LV catheterisation, and computed tomography (CT) before and immediately after TAVR. ESWS was estimated from echocardiography alone (ESWSEcho), combining CT LV dimensions and echocardiographic gradients (ESWSCT + echo) and combining CT LV dimensions and invasively measured LV end-systolic pressure (ESWSCT + Invasive). ESWSecho, ESWSCT + echo and ESWSCT + Invasive all decreased significantly after TAVR (89 ± 48 vs. 57 ± 37 Kdynes/cm2, P < 0.01; 69 ± 8 vs. 51 ± 8 Kdynes/cm2, P < 0.01, and 197 ± 69 vs. 137 ± 48 Kpa/cm2, P < 0.01, respectively). We observed weak to moderate associations between the methods. After TAVR, LVEF corrected to ESWSecho, ESWSCT + echo and ESWSCT + Invasive increased (0.93 ± 0.07 vs. 1.91 ± 2.1, P = 0.013; 0.36 ± 0.19 vs. 0.58 ± 0.33, P < 0.01, and 0.3 ± 0.02 vs. 2.5 ± 1.5, P < 0.01, respectively). Conclusion ESWSecho, ESWSCT + echo and ESWSCT + Invasive decreased significantly after TAVR suggesting they reflect afterload, but independent of method, ESWS corrected LVEF increased slightly post-TAVR, indicating load dependency.
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Laursen et al. (2025) conducted an observational in severe aortic stenosis (n=41). Transcatheter aortic valve replacement (TAVR) vs. Pre-TAVR baseline was evaluated on Changes in end-systolic wall stress (ESWS) and ESWS corrected LVEF (p=<0.01).
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