Non-invasive pressure-volume analysis: a novel method for evaluating ventricular function in patients with aortic stenosis

Darijan Ribic; Espen W Remme; Otto A Smiseth; Richard J Massey; Christian H Eek; John-Peder Escobar Kvitting; Lars Gullestad; Kaspar Broch; Kristoffer Russell

doi:10.3389/fcvm.2025.1740710

Non-invasive pressure-volume analysis: a novel method for evaluating ventricular function in patients with aortic stenosis

Front Cardiovasc Med. 2026 Jan 22:12:1740710. doi: 10.3389/fcvm.2025.1740710. eCollection 2025.

Authors

Darijan Ribic^{1

2}, Espen W Remme^{3

4}, Otto A Smiseth^{2

3}, Richard J Massey¹, Christian H Eek¹, John-Peder Escobar Kvitting^{2

5}, Lars Gullestad^{1

2}, Kaspar Broch^{1

2}, Kristoffer Russell¹

Affiliations

¹ Department of Cardiology, Oslo University Hospital, Oslo, Norway.
² Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
³ Institute of Surgical Research, Oslo University Hospital, Oslo, Norway.
⁴ The Intervention Centre, Oslo University Hospital, Oslo, Norway.
⁵ Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.

Abstract

Background and aims: Conventional echocardiographic measurements like ejection fraction (EF) and global longitudinal strain (GLS) evaluate left ventricular (LV) function without considering concurrent loading conditions. A more comprehensive characterization of cardiac function and energetics can be achieved through pressure-volume analysis, but its clinical application is limited by the requirement for invasive measurements. We aimed to develop a clinically accessible, non-invasive method for pressure-volume loop analysis.

Methods: We obtained simultaneous 3-dimensional echocardiograms and invasive LV pressures with micromanometer-tipped catheters during transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Volume-time traces from the echocardiograms were combined with invasive LV pressures and non-invasive pressure estimates to construct pressure-volume loops. We used echocardiograms before and after TAVR to evaluate changes in myocardial function via non-invasive pressure-volume studies.

Results: In same-beat comparisons, stroke work calculated using non-invasive LV pressure estimations correlated well with stroke work calculated using invasive LV pressures (r = 0.95, ICC = 0.95, p < 0.0001, y = 0.90X + 1,836, mean bias -549 mmHg*mL, standard deviation 774 mmHg*mL; 95% limits of agreement: -2,006 to +967 mmHg*mL). After TAVR, stroke work fell substantially, ventricular efficiency increased, ventriculo-arterial coupling improved, and both total and resting energy consumption decreased. On the other hand, LV biplane EF and GLS remained unchanged.

Conclusions: This study confirms the validity and clinical accessibility of non-invasive pressure-volume loop analysis in patients with aortic stenosis. The method identified and characterized changes in myocardial energetics, function, and ventriculo-arterial interaction, that are not typically detected by conventional echocardiography. These findings highlight the potential of non-invasive pressure-volume analysis in clinical and research practice.

Keywords: aortic stenosis; load dependency; myocardial energetics; pressure-volume loops; ventricular function.