Valvular & structural heart disease
Activation of the Anrep Effect in Aortic Stenosis Pre-TAVR and Post-TAVR: An Echocardiographic Pressure-Volume Analysis
Authors' conclusion
In severe AS, the Anrep effect supports output at high energetic cost. TAVR reverses this state, unloading the heart and reducing mechanical demand without altering ejection fraction.
Study context
- Population
- Patients with high-gradient aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR)
- Participants
- 119 patients
- Exposure
- Pre-TAVR vs 24 h post-TAVR
- TAVRn = 119
- Outcome
- "Anrep triad": elevated afterload (LV end-systolic pressure, effective arterial elastance), enhanced contractility (end-systolic elastance, end-systolic volume at 150 mm Hg) and prolonged systolic ejection time, by echocardiographic PV loops
- Follow-up
- Before and 24 hours after TAVR
Main finding
As reported in the abstract
Anrep triad (afterload, contractility, systolic ejection time), before vs 24 h after TAVR
- Left ventricle (LV) end-systolic pressure, before vs after TAVR (mm Hg)
- 220 vs 143
- Effective arterial elastance, before vs after TAVR (mm Hg/mL)
- 2.8 vs 2.0
- End-systolic elastance, before vs after TAVR (mm Hg/mL)
- 4.5 vs 2.6
- End-systolic volume at 150 mm Hg, before vs after TAVR (mL)
- 39 vs 53
- Systolic ejection time, before vs after TAVR (ms)
- 390 vs 321
Observational data: associations, not effects.
Further findings
LVEF, before vs after TAVR · 24 h after TAVR
- LVEF unchanged, before vs after TAVR
- 56% vs 56%, P = 0.44
LV energetics (stroke work (SW), PV area (PVA), mechanical efficiency), before vs after TAVR · 24 h after TAVR
- SW decreased, before vs after TAVR (mm Hg mL)
- 9,017 vs 6,257
- PVA decreased, before vs after TAVR (mm Hg mL)
- 14,261 vs 10,017, P < 0.0001
- Mechanical efficiency preserved, before vs after TAVR
- 64% vs 63%, P = 0.101
Original publication
Activation of the Anrep Effect in Aortic Stenosis Pre-TAVR and Post-TAVR: An Echocardiographic Pressure-Volume Analysis. JACC Adv. Published 17 December 2025. doi:10.
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