Clinical problem: Regardless of prognostic benefit of aortic valve replacement in aortic stenosis, some patients fail to derive a symptomatic/quality of life benefit, remaining in a heart failure with preserved ejection fraction (HFpEF)-like state. Why is this? Can lack of symptomatic improvement be predicted?
Aim: to investigate the disease mechanisms and predict symptomatic response to the intervention by a combination of unique clinical data (a registry enriched by invasive pressure volume recordings), echocardiographic measurements of LV filling pressures and mechanics (including indices by our recent patented technology) digital twin models of cardiac contraction and energetics, and a prospective study to test prediction.
Overarching hypothesis: the mechanism that explains and thus predicts response is the loss of the “cardiac resilience”, i.e. the ability of the heart to improve function beyond current health status. The key is to define the specific mechanism of resilience, and we speculate on the material compliance of the wall: subjects that display impaired LV mechanical properties (e.g. reduced elasticity/increased stiffness) are not expected to improve after vale intervention.
