Activation of the Anrep Effect in Aortic Stenosis - Pre-TAVR and Post-TAVR An Echocardiographic Pressure-Volume Analysis

Q: What is the Anrep effect in aortic stenosis, and why is it clinically important?

The Anrep effect is an afterload-dependent adaptive response marked by increased myocardial contractility and prolonged systolic duration. In severe aortic stenosis, it supports output but does so at increased energetic cost.

Q: How was the Anrep effect assessed in the study?

Pressure-volume loops were analyzed by echocardiography before and 24 hours after TAVR. The study evaluated the Anrep triad using afterload, contractility, and systolic duration measures, and quantified energetics with stroke work, potential energy, PV area, and efficiency.

Q: What changes occurred after TAVR with respect to afterload, contractility, and systolic duration?

TAVR reduced afterload and contractility measures while shortening systolic duration. Stroke work and pressure-volume area decreased, whereas mechanical efficiency was preserved.

Sep 29, 2026

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Aortic stenosis study examines whether the intrinsic, afterload-dependent Anrep effect remains chronically activated in severe disease and whether it reverses after transcatheter aortic valve replacement. Pressure-volume loops from 119 high-gradient patients are analyzed by echocardiography before intervention and at 24 hours post-TAVR. The work evaluates the Anrep triad, stroke work, potential energy, pressure-volume area, and mechanical efficiency to characterize ventricular energetics.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Objectives

Methods

Results

Conclusions

J A C C : A D V A N C E S V O L . 5 , N O . 1 , 2 0 2 6 © 2 0 2 6 T H E A U T H O R S . P U B L I S H E D BY E L S E V I E R O N B E H A L F O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O GY F O U N D A T I O N . T H I S I S A N O P E N A C C E S S A R T I C L E U N D E RT H E C C B Y L I C E N S E ( [h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y / 4 . 0 /](h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y / 4 . 0 /) ) . ORIGINAL RESEARCH Activation of the Anrep Effect in Aortic Stenosis Pre-TAVR and Post-TAVRAn Echocardiographic Pressure-Volume Analysis Jan-Christian Reil, MD,a,* Vasco Sequeira, PHD,b,* Philipp Lucas, MD,a Lea Tadros,a Gert-Hinrich Reil, MD,c Jan M. Federspiel, MD,b,d Smita Scholtz, MD,a Hazem Omran, MD,a Paul Steendijk, PHD,e Christoph Marquetand, MD,f Werner Scholtz, MD,a Cornelia Piper, MD,a Tanja Rudolph, MD,a Volker Rudolph, MDa ABSTRACT BACKGROUND In aortic stenosis (AS), chronic pressure overload of the left ventricle (LV) may sustain an intrinsic, afterload-dependent adaptive response known as the Anrep effect, characterized by increased myocardial contractility and prolonged systolic duration. Whether this response resolves following transcatheter aortic valve replacement (TAVR) remains unknown. OBJECTIVES The objective of the study was to determine whether the Anrep is chronically activated in severe AS and acutely reverses after TAVR. METHODS We studied 119 patients with high-gradient AS undergoing TAVR. Pressure-volume (PV) loops were analyzed by echocardiography before and 24-hours after intervention. The “Anrep triad”, defined as 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, was assessed. Stroke work (SW), potential energy, PV area (PVA), and mechanical efficiency (SW/PVA) quantified LV energetics. RESULTS TAVR reduced afterload (LV end-systolic pressure: 220 vs 143 mm Hg; effective arterial elastance: 2.8 vs 2.0 mm Hg/mL) and contractility (end-systolic elastance: 4.5 vs 2.6 mm Hg/mL; end-systolic volume at 150 mm Hg: 39 vs 53 mL), while shortening systolic duration (systolic ejection time: 390 vs 321 ms) (all P < 0.0001) . LV ejection fraction was unchanged (56% vs 56%, P = 0.44) . Mechanical workload decreased (SW: 9,017 vs 6,257 mm Hg mL; PVA: 14,261 vs 10,017 mm Hg mL, P < 0. 0001), while efficiency was preserved (64% vs 63%, P = 0.101) . CONCLUSIONS 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. This identifies the Anrep as a clinically relevant load-dependent mechanism in AS and highlights its reversibility post-TAVR. (JACC Adv. 2026;5:102424) © 2026 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). From the aKlinik für allgemeine und interventionelle Kardiologie, Herz-und Diabetes Zentrum Nordrhein-Westphalen, Bad Oeynhausen, Germany; bComprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany; cUniversitätsklinik für Innere Medizin – Kardiologie, Klinikum Oldenburg, Oldenburg, Germany; dInstitute for Legal Medicine, Faculty of Medicine, Saarland University, Homburg, Saarland, Germany; eDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; and the fDepartment of Cardiology, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany. *These authors contributed equally to this work. The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’institutions and Food and Drug Administration guidelines,

FAQs

What is the Anrep effect in aortic stenosis, and why is it clinically important?

The Anrep effect is an afterload-dependent adaptive response marked by increased myocardial contractility and prolonged systolic duration. In severe aortic stenosis, it supports output but does so at increased energetic cost.

How was the Anrep effect assessed in the study?

Pressure-volume loops were analyzed by echocardiography before and 24 hours after TAVR. The study evaluated the Anrep triad using afterload, contractility, and systolic duration measures, and quantified energetics with stroke work, potential energy, PV area, and efficiency.

What changes occurred after TAVR with respect to afterload, contractility, and systolic duration?

TAVR reduced afterload and contractility measures while shortening systolic duration. Stroke work and pressure-volume area decreased, whereas mechanical efficiency was preserved.

Sep 29, 2026

Uploaded by Bintang