# TAVI herstelt frequentie-afhankelijke myocardiale reserve bij ernstige aortastenose

*geplaatst 2026-10-22 · Algemeen · American journal of physiology. Heart and circulatory physiology · doi 10.1152/ajpheart.00441.2026 · https://hartvaat.nl/2026/11/01/tavi-herstelt-frequentie-afhankelijke-myocardiale-reserve-bij-ernstige-aortasten/*

In een prospectieve studie met 46 patiënten met ernstige aortastenose en een behouden ejectiefractie onderzochten onderzoekers of TAVI de frequentie-afhankelijke myocardiale reserve herstelt. Invasieve metingen toonden aan dat de klepimplantatie direct de systolische en lusitrope reserve herstelt, wat zich drie maanden later uit in een verbeterde diastolische functie en lagere pulmonale arteriële druk. Deze bevindingen bevestigen dat de door drukbelasting veroorzaakte myocardiale remodellering functioneel omkeerbaar is door acute afterloadverlaging. Voor de cardioloog onderstreept het de fysiologische meerwaarde van TAVI, hoewel het geen directe impact heeft op de klinische besluitvorming.

## English: Restoration of frequency-dependent myocardial reserve after TAVI in severe aortic stenosis: an invasive hemodynamic study.

In a prospective study of 46 patients with severe aortic stenosis and preserved LVEF, researchers investigated whether TAVI restores frequency-dependent myocardial reserve. Invasive hemodynamic measurements demonstrated that acute valve implantation immediately restores both systolic and lusitropic reserve, with corresponding improvements in diastolic function and pulmonary pressures observed at three months. These findings confirm that pressure-overload-induced myocardial remodeling is functionally reversible following afterload reduction. While primarily mechanistic, the study reinforces the physiological rationale for timely TAVI in selected patients.

## Abstract (original, from the publication)

Severe aortic stenosis (AS) and chronic pressure overload may impair frequency-dependent myocardial reserve despite preserved left ventricular ejection fraction (LVEF). We investigated whether acute afterload reduction with transcatheter aortic valve implantation (TAVI) restores force-frequency relationships (FFR) and relaxation frequency relationships (RFR). In this prospective study, patients with severe normal-flow, high-gradient AS and preserved LVEF underwent invasive left ventricular pressure recording during incremental atrial pacing at 80 and 100 beats/min before and immediately after TAVI. Systolic reserve was assessed using dP/dtmax and preload-adjusted indices [dP/dtmax/left ventricular end-diastolic pressure (LVEDP) and left ventricular peak systolic pressure (LVSP)/LVEDP], whereas lusitropic reserve was assessed using dP/dtmin, the relaxation constant τ, and LVEDP. Echocardiography was performed at baseline and 3 mo. Forty-six patients completed the pacing protocol. Before TAVI, pacing produced only a modest increase in dP/dtmax (Δ + 150 mmHg/s; P = 0.004), without improvement in dP/dtmin (P = 0.329) or τ (P = 0.182). Immediately after TAVI, pacing increased dP/dtmax (P < 0.001), dP/dtmax/LVEDP (P = 0.004), and LVSP/LVEDP (P = 0.031), while improving dP/dtmin (Δ + 56 mmHg/s; P = 0.050) and τ (P = 0.033) and reducing LVEDP (P = 0.017). Correlation analyses supported the emergence of physiological FFR and RFR after valve implantation. At 3 mo, echocardiography showed lower pulmonary artery systolic pressure (P = 0.002), improved left atrial reservoir strain, and lower diastolic dysfunction grade (P = 0.006). Thus, acute afterload relief with TAVI reveals preserved dynamic systolic and lusitropic reserve in severe AS, with subsequent group-level improvement in diastolic function.NEW & NOTEWORTHY This study provides direct invasive human evidence that frequency-dependent myocardial reserve is acutely restored after TAVI in severe aortic stenosis. Controlled atrial pacing revealed blunted force-frequency and relaxation-frequency responses before valve replacement, despite preserved ejection fraction, with rapid recovery after afterload relief. These findings show that impaired myocardial reserve in pressure-overload remodeling is functionally reversible and tightly linked to loading conditions.

Auteurs: Emiliano Fiori, Dimitri Buytaert, Michele Mattia Viscusi, Raffaella Mistrulli, Sara Corradetti, Tatyana Storozhenko, Anthony Kechichian, Nikolaos Stalikas, Eric Wyffels, Riet Dierckx, Emanuele Barbato, Ward A Heggermont, Jeroen Dauw, Jozef Bartunek, Marc Vanderheyden

---
Bron: American journal of physiology. Heart and circulatory physiology, https://doi.org/10.1152/ajpheart.00441.2026. Bijgewerkt 2026-10-16T00:52:47Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.