ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Valve Disease
This article is part of the Research TopicLifetime Management for Aortic Stenosis: What Should We Consider?View all 4 articles
Homeometric Autoregulation in Severe Aortic Stenosis: Insights from Transcatheter Aortic Valve Replacement
Provisionally accepted
Adam J Doerr1,2
Matthew Gottbrecht2*Nikolaos Kakouros2
Matthew Parker2Colleen M Harrington2Gerard P Aurigemma2- 1Saint Vincent Hospital, Worcester, United States
- 2UMass Memorial Medical Center, Worcester, United States
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Background: In severe aortic stenosis (AS), relief of afterload excess would be expected to improve left ventricular ejection fraction (LVEF). However, the response of LVEF to transcatheter aortic valve replacement (TAVR) is variable, with some patients even demonstrating a decline. The mechanisms underlying this phenomenon are incompletely characterized. Accordingly, we investigated changes in systolic function in the near-term postoperative period following TAVR. Methods: We studied consecutive patients with severe AS referred for TAVR without identifiable perioperative sources of negative inotropy or ventricular dyssynchrony. Preoperative and postoperative day one echocardiograms were compared with respect to hemodynamics, LV geometry, LVEF, and midwall fractional shortening (FSmw). Contractility was assessed by comparing observed FSmw values to those predicted based on the stress-shortening relation of healthy controls. Results: Thirty-six patients were included (61% women; mean age 77 years; mean STS mortality risk score 3.6%). Following TAVR, there was a precipitous decline in circumferential end-systolic wall stress from 122 ± 47 to 74 ± 32 kdynes/cm2 (p <0.001) and a slight increase in LVEF. Surprisingly, however, there was also an increase in the percentage of patients with depressed contractility from 22% (8) to 78% (28) (p <0.001). Heart rate and ventricular volumes remained unchanged. Conclusions: Contractility declined in the near-term postoperative period following TAVR. We interpret this finding to mean contractility is augmented by high afterload in severe AS and declines in parallel with afterload reduction. We speculate autoregulatory mechanisms triggered by high valvular resistance support LVEF in severe AS and rapidly abate following TAVR.
Keywords: Aortic stenosis (AS), Homeometric autoregulation, Ventricular adaptation, Transcatheter aortic valve replacement, Echocardiography
Received: 31 Jul 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Doerr, Gottbrecht, Kakouros, Parker, Harrington and Aurigemma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Matthew Gottbrecht
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