Acute bi-ventricular haemodynamic changes after transcatheter aortic valve implantation for severe aortic stenosis assessed using invasive pressure-volume loops

Q: What are the key findings of this study?

Transcatheter aortic valve implantation significantly reduced left ventricular effective arterial elastance from 2.1 to 1.4 mmHg/mL and improved bi-ventricular ventriculo-arterial coupling.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe symptomatic aortic stenosis (n=12). Intervention: Transcatheter aortic valve implantation (TAVI) vs. Pre-TAVI baseline. Primary outcome: Left ventricular effective arterial elastance (Ea) (p=<0.001).

Q: What does this research mean for the field?

Transcatheter aortic valve implantation for severe aortic stenosis acutely reduces afterload, improves ventriculo-arterial coupling, and decreases myocardial metabolic demand in both the left and right ventricles. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To quantify the acute bi-ventricular haemodynamic response, ventriculo-arterial coupling, and myocardial energetics following TAVI for severe symptomatic aortic stenosis using invasive pressure-volume loops.

Vitaliy Androshchuk; Edouard Long; Omar Chehab; Joshua Wilcox; Benedict McDonaugh; Ronak Rajani; Bernard Prendergast; Tiffany Patterson; Simon Redwood

doi:10.1007/s12928-026-01295-x

May 23, 2026Cardiovascular Intervention and TherapeuticsOpen Access

Acute bi-ventricular haemodynamic changes after transcatheter aortic valve implantation for severe aortic stenosis assessed using invasive pressure-volume loops

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Key result

TAVI linked to ~33% lower LV effective arterial elastance and improved bi-ventricular ventriculo-arterial coupling.

P<0.001
n=12

Figures

Why the study?

The early haemodynamic impact of transcatheter aortic valve implantation (TAVI) on bi-ventricular performance remains poorly characterised.

Does transcatheter aortic valve implantation improve acute bi-ventricular haemodynamics in patients with severe symptomatic aortic stenosis?

Key Points

To quantify the acute bi-ventricular haemodynamic response, ventriculo-arterial coupling, and myocardial energetics following TAVI for severe symptomatic aortic stenosis using invasive pressure-volume loops.
Prospective study evaluating 12 patients (median age 84.1 years [IQR: 77.1, 87.2]; 25% female) undergoing TAVI with balloon-expandable prostheses in 75.0%.
Left and right ventricular pressure-volume loops were recorded using conductance catheters immediately pre- and post-TAVI (LV analysis in n=12, RV analysis in n=10).
TAVI induced significant bi-ventricular reductions in arterial afterload, with effective arterial elastance falling in the LV from 2.1 (1.8, 2.3) to 1.4 (1.3, 1.7) mmHg/mL (p < 0.001) and in the RV from 0.5 (0.4, 0.6) to 0.4 (0.3, 0.4) mmHg/mL (p = 0.006).
Ventriculo-arterial coupling improved significantly in both the LV (Ea/Ees: 0.7 [0.6, 0.7] to 0.6 [0.5, 0.6], p = 0.003) and the RV (Ees/Ea: 1.1 [0.9, 1.3] to 1.3 [1.1, 1.4], p = 0.006), despite an acute decrease in LV end-systolic elastance (3.2 to 2.6 mmHg/mL, p = 0.021).
Both ventricles showed significant reductions in stroke work (LV-SW: 11,915.0 to 7,360.5 mmHg.mL, p < 0.001; RV-SW: 1,506.9 to 1,418.1 mmHg.mL, p = 0.020) and pressure-volume area (LV-PVA: 16,188.5 to 9,674.2 mmHg.mL, p < 0.001; RV-PVA: 2,176.1 to 1,960.2 mmHg.mL, p = 0.002).

Study Design

Type

Observational (n=12)

Multicenter

No

Structured PICO

Does transcatheter aortic valve implantation improve acute bi-ventricular haemodynamics in patients with severe symptomatic aortic stenosis?

P

Population

12 patients with severe symptomatic aortic stenosis, median age 84.1 years (IQR 77.1-87.2), 25% female.

I

Intervention

Transcatheter aortic valve implantation (TAVI)

C

Comparator

Pre-TAVI baseline (within-patient comparison)

O

Outcome

Acute bi-ventricular haemodynamic changes (contractile function, ventriculo-arterial coupling, and energetics) measured by invasive pressure-volume loops immediately post-TAVIsurrogate

Main Result

Absolute Event Rate: 1.4% vs 2.1%

p-value: p=<0.001

TAVI for severe aortic stenosis provides immediate bi-ventricular unloading, improves ventriculo-arterial coupling, and reduces myocardial metabolic demand.

Limitations

Small, exploratory, single-centre study limiting generalisability.
Impact of the observed haemodynamic changes on clinical outcomes was not ascertained.
Potential influence of subtle intra-procedural variations in conscious sedation level, blood viscosity, catheter position, AS severity, valve type/size or rapid ventricular pacing.
Single-beat estimation of ESPVR assumed a fixed volume-axis intercept (V0) at zero.

Implication

Acute TAVI unloading may lower myocardial demand; hypothesis-generating and requires prospective validation before practice change.

Abstract

Transcatheter aortic valve implantation (TAVI) aims to relieve the increased left ventricular (LV) afterload imposed by aortic stenosis (AS). However, the early haemodynamic impact of TAVI on bi-ventricular performance remains poorly characterised. This prospective study quantified the acute bi-ventricular response following TAVI for severe symptomatic AS using gold-standard invasive pressure-volume loop (PVL) assessment. Left and right ventricular (RV) PVLs were recorded using a conductance catheter pre- and immediately post-TAVI. Indices of contractile function, ventriculo-arterial coupling and energetics were derived. In total, 12 patients (84.1 years [interquartile range: 77.1, 87.2]; female 25%) were included. TAVI resulted in significant bi-ventricular reductions in afterload, measured by effective arterial elastance (LV: 2.1 [1.8, 2.3] to 1.4 [1.3, 1.7] mmHg/mL, p < 0.001; RV: 0.5 [0.4, 0.6] to 0.4 [0.3, 0.4] mmHg/mL, p = 0.006). Despite an acute decline in LV contractility, measured by end-systolic elastance ( p = 0.021), there was a significant net improvement in ventriculo-arterial coupling in both the LV ( p = 0.003) and RV ( p = 0.006). Both the LV and RV demonstrated significant reductions in stroke work (SW) (LV-SW: 11,915.0 [9,727.5, 15,288.7] to 7,360.5 [6,937.0, 9,113.1] mmHg/mL, p < 0.001; RV-SW: 1,506.9 [1,420.5, 1,676.2] to 1,418.1 [1,250.8, 1,510.3] mmHg/mL, p = 0.020) and pressure volume area (PVA) (LV-PVA: 16,188.5 [13,171.5, 18,726.5] to 9,674.2 [9,185.9, 11,872.2] mmHg/mL, p < 0.001; RV-PVA 2,176.1 [2,046.3, 2,885.1] to 1,960.2 [1,835.6, 2,269.0] mmHg/mL, p = 0.002), with stable SW/PVA ratios. The acute haemodynamic effects of TAVI for severe symptomatic AS extend beyond the LV. Patients experienced bi-ventricular unloading, improved ventriculo-arterial coupling and reduced myocardial metabolic demand. Schematic illustration of changes in bi-ventricular pressure-volume loops following TAVI, representing cohort-averaged data rather than direct measurements, together with the key study findings. EDP: end-diastolic pressure; EDPVR: end-diastolic pressure-volume relationship; ESP: end-systolic pressure; ESPVR: end-systolic pressure-volume relationship; LV: left ventricle; RV-PA: right ventricle-pulmonary arterial; SW: stroke work; TAVI: transcatheter aortic valve implantation.

Discussion

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Cite This Study

Androshchuk et al. (2026) conducted an observational in Severe symptomatic aortic stenosis (n=12). Transcatheter aortic valve implantation (TAVI) vs. Pre-TAVI baseline was evaluated on Left ventricular effective arterial elastance (Ea) (p=<0.001). Transcatheter aortic valve implantation significantly reduced left ventricular effective arterial elastance from 2.1 to 1.4 mmHg/mL and improved bi-ventricular ventriculo-arterial coupling.

synapsesocial.com/papers/6a13ea160e02ee3982d3372e https://doi.org/10.1007/s12928-026-01295-x

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Acute bi-ventricular haemodynamic changes after transcatheter aortic valve implantation for severe aortic stenosis assessed using invasive pressure-volume loops

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Acute bi-ventricular haemodynamic changes after transcatheter aortic valve implantation for severe aortic stenosis assessed using invasive pressure-volume loops

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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