960
ABSTRAKTY425200011158114164221282345406464520
Z971200011151
KONGRESU1048200011156116178239299356406466
/1540200011132
CONGRESS1598200011154116177239299355406456
ABSTRACTS2080200011158114164221282345401459509
(LIVES)425320097236080125166206229
Physiology6713200974287124156175220240284330369
is10573200971951
the11253200972671112
only12543200974489109147
polar14183200974691111150177
star1612320097315999126
we17553200975899
have18713200974483121161
–204932009740
unikátní21063200974489108146186213258277
akce24003200973977112152
proběhla25693200974673117163205250269308
již2894320097203974
potřetí29853200974591118144185212231
v323332009739
Praze32893200974268108143184
11817420001113676124
|343200011126
ANESTEZIOLOGIE4268040010753112155200245290342362425467527586607650
A10988040010753
INTENZIVNÍ1172804001071978123168227276296345405426
MEDICÍNA16198040010770114174195248268328382
/20468040010732
Anest21238040010753101145179208
intenziv235080400107196794137185222241282
Med.26528040010770114164180
2026;37(2):116-1252852804001074487128170185230270290333355370407441480510549586630
/35278040010732
www.aimjournal.cz48358040010765133201214257275349367415463490539579598614654693
to42562001052773
the51962001052774118
higher65862001054765113160204229
metabolic908620010573116143184232281300318357
needs128662001054891135184216
and152362001054087135
improve168062001051890138165211250293
the199462001052774117
systemic213262001053373107135177249267307
perfusion246062001054892118145193225243290337
an281862001054087
echocardiography-guided42576001054282129176216256281328346392441466506554601639665715761779827869918
optimization135876001054795122140211229265305332350396443
of181776001054770
BiVAD190376001054462107154210
pump212976001054895166214
parameters235976001054889114154226269295337362395
was2770760010563103135
performed.42590001054890115141186211282324371386
Results:82690001054486118162180206239253
In109490001051964
BiVAD-supported117390001054461106152207235267312359406453478508548595
patients,178390001054888113131172218243276291
the208990001052772114
increased221890001051864102127168206237279327
metabolic2560900010571113139178225272290307346
and425104001054087135
circulatory58310400105395783121168187226253299325367
demands973104001054891163203250298331
associated1326104001054073105153193211251278319368
with1717104001056382110157
sepsis1896104001053376125158176208
cannot2126104001054080127174222249
be2397104001054993
adequately2512104001054088132180227267294335354393
met4251180010574119147
due599118001054997141
to767118001052875
limited869118001051938112131160203254
or1150118001054875
absent1252118001054191125170219246
native1525118001054889117136178222
cardiac1774118001054082109158177218259
reserve.2060118001052670104149176220264279
Compensatory2366118001055299173223269318351394421468496539
mechanisms4251320010572115156203243290308340412444
as892132001054072
tachycardia987132001052767107154192231271297344363402
and1412132001053987135
enhanced1569132001054390137177224264306355
myocardial19461320010572110156197237263310329368387
contractility2355132001053985133159185226266296314332351378420
are2797132001054066108
absent425146001054089121165212238
or687146001054673
markedly7831460010572112138176218267286325
blunted.1131146001054968115162188230279294
Moreover,14491460010568116142184232272314340352
the1824146001052775118
absence1965146001054089122165212252293
of2282146001054770
pulsatile2376146001054896114146187214232251294
blood2693146001054968115163212
flow42516000105234592156
leads603160001051862101149182
to807160001052772
impaired901160001051991139180198224266315
regulation1238160001052668117164182222249267314362
of1622160001054770
vascular1714160001054081113153200219258284
tone.2020160001052773121164178
This2220160001054190108140
results2382160001052668101148166193228
in2632160001051865
a27191600010540
dissociation278116000105486698425174001053381121140179206225272320
between771174001054893120186229273321
pump1117174001054997169218
flow,136117400105234592156169
arterial155517400105406697139165184224242
pressure,1823174001054976118151184230256299313
and2162174001054087136
tissue232417400105274678111157200
perfusion.2550174001054993119146194226245292340356
Sepsis-induced425188001054184133166184216241261308356403442484533
systemic975188001053373106135177249267306
vasodilation1299188001053980113160209227246286312331378425
further174218800105237196127174217243
aggravates2002188001054089137163204243283310352385
the2404188001052774118
imbalance2539188001051890139179198238285325366
between425202001054993120186229272320
fixed76420200105244381123172
or956202001054773
semi-fixed1049202001053376148167194218237276318367
cardiac1436202001053979105153171210250
output1706202001054794122171218246
and1971202001054087136
reduced2127202001052668117163203245294
systemic2441202001053273106134176248266306
vascular2767202001053980113425216001053986105144170
resistance,617216001052668101119151179220267307348362
creating1001216001053965107147173192239287
a13102160010539
complex1371216001053985157206225268307
hemodynamic1700216001054790162210259298347386458477516
state2238216001053361102128170
characterized2429216001054087127152193233263304330349385427476
by425230001054987
features530230001052366105132179205247280
of828230001054770
both917230001054896123170
cardiogenic1106230001053979105153171218267310357375415
and1539230001054087135
distributive169323000105486698126153172220267295313354396
shock.2107230001053380127168205223
Even2348230001054180122169
though2536230001052774121169217264
an2818230001054087
integrated42524400105186590132180206246272313361
therapeutic802244001052774117142183230274320347365404
approach1222244001054088136162208248287334
incorporating1571244001051965104149175224271298338364382428476
pump2063244001054895166214
flow229324400105234491154
optimization2462244001054795122140211229265305332350396443
and425258001053986133
multimodal5742580010571117135161179250297345384402
organ991258001054772119158204
support1210258001053378126174221247276
in1502258001051864
this158225800105267391122
case1719258001053979111153
was18882580010563102134
associated2038258001053971103150189207246272312361
with2414258001056381108154
favorable2584258001052363101147173213260279321
clinical42527200105395876123141180221240
outcome,689272001054794121159205277321335
the1048272001052775118
treatment119027200105275396135161234277324351
is1565272001051850
significantly163927200105335199146164188207247287335361380419
prolonged.2082272001054975121140188235284327376392
Conclusion:2498272001055096143183201248280298345393407
The425286001054293138
coexistence590286001054188134175195229258302351393436
of1053286001054973
constrained1154286001054088138171201229271291340385436
cardiac1617286001054183110160179220262
output1906286001054898127178227256
and2189286001054291141
sepsis-induced2357286001053479130164183217244265314364412454497548
vasodilation425300001054080113161210228246286313331378426
in870300001051966
a9553000010540
patient1015300001054989116134177224251
supported1285300001053379128177225251282323373
with1677300001056483110157
BiVAD1854300001054463109156213
produces2087300001054875121170217256298331
a24373000010540
mixed2497300001057290129171220
form273630000105237096169
of425314001054873
cardiogenic525314001054083110159178227278322371391432
and984314001054190140
distributive1151314001054969102132159179229279308327369413
shock1591314001053482132174212
with1830314001056686114163
impaired2021314001051993143185205232276326
compensatory2375314001054087162213258307341384412459487530
mechanisms.4253280010572115156203242289308340411444460
Recognition901328001054588128174223270288316334381429
of1346328001054770
this143332800105277492124
unique1573328001054794112160207250
hemodynamic1839328001054791163210259298346386458476516
profile2371328001054975121145164182225
is2613328001051850
essential268032800105427510815119842534200105274685104
for54834200105237096
appropriate664342001054088137164210259285304344370412
monitoring10953420010573120168186213259286304351400
and1514342001054087136
therapeutic1669342001052775118144185233277324351370409
strategies.209834200105336187128155196245264307340356
To2474342001054082
achieve2576342001054080127145188228270
a28653420010540
hyperdynamic425356001054783132175200247285332371442460498
response,93935600105256799146193240271314328
a12823560010539
multimodal13373560010571117135161179250296344383401
management17543560010571110156195242285355398444470
strategy223935600105336086126152192240279
is2534356001051849
required,2598356001052667115161178204245293307
in425370001051865
which5093700010563111129168215
pump743370001054896168216
flow97737000105234593156
may11513700010572112150
be1319370001054993
adjusted,1430370001054089107154186214256305320
with1769370001056382109157
careful1944370001053980106148171219238
consideration2200370001053985132165183231274300341367386433480
of2699370001054670
the2787370001052775118
associated425384001054073105153193211251277319368
risk81238400105264577114
of946384001054670
suction1035384001053379119148167214262
events.1316384001054382125172198232249
Haemodynamic-energetic425408001538514920831137644750958464975479585389295310261085114512091267132013611419
mechanism186740800153101161219293357432474528632
of4254220015364112
sudden5604220015351124194265324397
cardiac9804220015356120183254296361418
death14214220015369129192243317
in17604220015339114
severe18974220015351112176235296357
aortic22764220015362127187242282341
stenosis:4254360015351104165238302356397452485
A9334360015382
modelling103843600153102166238297337378419495558
study16194360015352104176246308
Martin4254570012485138177216244304
Dvouletý1,7494570012469124180239267321358413116145800733211934570012426
Michal12394570012485113159218272300
Šitina1,1559457001245481118147206260181245800733246
2,187045800733350
3,193245800733248
41992458007332
1Department4254770071304534760012167118175223256292375425481513
of988476001215584
Pathological10934760012153100133188243267322379402447495519
Physiology,16334760012153108153193216271295350407454470
Faculty2125476001214893138192216249299
of2445476001215584
Medicine,4684890012180131188212256279335385405
Masaryk8944890012180129168217250300348
University,12634890012164119143191240273313336369419435
Brno,1719489001215487143198218
Czech19584890012158103153198253
Republic22334890012153104161216273297320365
2Department4255030071304565020012167118175223256292375425481513
of991502001215584
Internal1096502001212479112161194250298321
Medicine14385020012181131189212257279335385
I,1844502001212445
Cardiology19115020012158106139195218273297352409457
and23895020012148103160
Intensive468515001212479112161217256278327376
Care8655150012158107139189
Medicine,10755150012180131188212256279335385405
Landesklinikum1501515001214797152209259299345370393448471518574657
MistelbachGänserndorf,217951500121801041431772262503073564004564685280012165113169208258291347404459492524542
Mistelbach,10315280012181104143177227251307356401456476
Austria15295280012161115154188220244292
3Biostatistics,425542007130456541001215478133172206255287310349383406451492513
International990541001212479111161194249297330353408464512535
Clinical1546541001215881104159183227276299
Research18675410012153104143194242274319374
Center,22625410012158107162195244277293
St.468554001214981102
Anne´s5915540012161117172222248283
University8955540012164119143191240273313336369419
Hospital13355540012165121160217240273322346
Brno,1702554001215487143198217
Czech19415540012158102152198253
Republic22155540012154104162217274298321366
42nd4255680071304545670012151105162
Department6375670012167118175223256292375426481514
of1172567001215584
Internal1277567001212479112161194250298321
Medicine,16195670012181131189212257280335385405
St.2045567001215081102
Anne’s21685670012162117172223244279
University4685800012165120143191240273313336369419
Hospital9085800012166121160217241274322346
in1275580001212479
Brno,1375580001215487143198217
Czech16145800012158102152198253
Republic18885800012154104162217274298321366
Introduction:56560800105196590116161209255293322340386433446
Severe1028608001054184123164189230
aortic1276608001053986111141159197
stenosis1490608001053361101148194226243274
(AS)1781608001052474115138
is1936608001051849
a20026080010540
recognized2059608001052667107152200246263298340388
risk246460800105264475111
factor2592608001052363102131176202
for281160800105236894
sudden425622001053378126173216262
cardiac711622001053979104150168206245
death980622001054890129155201
(SCD).1205622001052362111167187200
While14286220010573120137155197
ventricular1649622001054081128153179197235281299338363
tachyarrhythmias2036622001052767106152189229254280326363393440511528567599
are2658622001054066107
the2789622001052773116
most4256360010572119151178
common624636001053984155226273320
immediate964636001051990161203251269308333374
cause1359636001053979124156198
of1578636001054669
SCD,1668636001054090145157
the1846636001052773116
majority19826360010572111129175201219246287
of2289636001054770
cases2379636001053979111153185
of2585636001054769
SCD2675636001054190146
in2841636001051965
patients425650001054888113130172218243276
with715650001056381107153
severe882650001053274113154179219
AS1116650001055191
exhibited1222650001054280126143190207234274322
bradyarrhythmia1558650001054873113160198237262287334370399445516533571
as2143650001054071
the2228650001052773115
primary235765000105487491162200225266
rhythm.2637650001052672108138184254269
Enhanced425664001054186131169214252292340
activation778664001054078106123162201226243288334
of1126664001054668
left120866400105186081111
ventricular1332664001054080126151175193231276293331355
baroreceptors1701664001054887111156181221260300346372416441473
(Bezold-Jarisch2188664001052365107142186204250276301339363381411449495
reflex)269666400105266688109150187209
has425678001054786118
been561678001054992135181
implicated760678001051989137156173211251277318366
in1144678001051864
the1226678001052874116
pathogenesis1360678001054989115161208256298344387419436467
of1845678001054770
syncope1933678001053372119158203251294
in2245678001051965
patients2328678001054888114132174220245279
with2625678001056381108154
AS.2798678001055192107
However,4256920010555100161201239280304314
the752692001052772113
precise879692001054772112150167197238
mechanism11316920010571112150195233278295325394
by1538692001054885
which16366920010563108125162207
an1856692001054085
otherwise1954692001054671116157182246263293334
benign2302692001054789134151197242
circulatory255769200105395579116160177215240283308348
syncope425706001053372119158203251294
can740706001053979125
progress885706001054974120168193234266298
to1203706001052872
cardiac1296706001053979104150168206245
arrest156170600105406591132164192
in1773706001051965
severe1858706001053376115156181222
AS2101706001055192
remains2214706001052667138177195241272
unclear.2507706001054692131149191230255266
We27937060010573113
propose425720001054873117164210241282
a7217200010539
hemodynamic-energetic774720001054688157203250288334372441458496517560605646671716757783800837
mechanism16257200010571112151196234279296326395
to2034720001052770
explain2118720001054279126144182199243
this237572000105277289119
progression2508720001054872116163188228259290306352397
and425734001054086134
demonstrate582734001054890161208255286314339379405445
its105173400105184578
plausibility1152734001054967106152183200248266283300327368
using154373400105477895141189
a17557340010540
mathematical18187340010572111137184226297336362380418458476
model23177340010572119167209227
of2567734001054770
cardiac2660734001053979104150168206245
hemodynamics425748001054891163210259298346385457475514548
and997748001054188136
energetics.1157748001054390133159206249275293333366382
Methods:15647480010569112139186233282314328
The1917748001054189132
mathematical20747480010573112138185228301340366384423464482
model25807480010573120169212231
of2835748001054770
cardiac425762001053979104150168206245
hemodynamics693762001054790161208256294342381452469508541
and1257762001054086134
energetics1414762001054288131156202245271289327360
developed1797762001054891130171189235284327375
in2195762001051864
this228276200105277491122
work24277620010564110135172
is2622762001051850
based2695762001054888120162210
on425776001054795
the544776001052875118
two-element686776001052793140168213231274346389436462
Windkessel1172776001057392139187224266298331374392
model15897760010572120168211230
of1843776001054770
arterial193877600105406696137162181220238
hemodynamics,2201776001054790162209258297345385457475514547563
the2788776001052774117
ventriculoarterial304762001054081128153178196235281298345385410439480505523562579
coupling364462001053984130178196214260307
model,3969620010572118166209227241
and422762001054086134
ventricular437862001054082128153179197235281299338363
energetics475862001054389132157203245272289328361
model.5137620010572118167209227242
The539662001054189131
model3047760010572118165207225
quantifies328676001054893131177202220242260302333
energy363476001054288130155200239
delivered388776001054789107124163204229269317
to421876001052771
the430476001052773115
heart443376001054789127151180
by462776001054986
the472776001052773115
coronary485676001053984109153200238263304
circulation51747600105395681118163180219244262307353
and304790001054188136
energy320890001054491134160208247
expenditure348090001054483132176223272290317365390432
of393790001054871
the403390001052875119
heart.417690001054892131157187203
Under4404900010556102151194220
physiological464990001054997135168186233252300349367406447465
conditions,513990001054086134182200228246293341373389
energy3047104001054389131156203242
delivery3308104001054890108126165206231273
is3600104001051950
higher3670104001054764111157200225
than3914104001052874113159
energy4093104001054389131156203241
expenditure.4354104001054381129172218266283310356381422436
Using4810104001055585102148196
the5025104001052874116
model,51611040010572119167209227241
we54221040010563105
examined3047118001054280119189206251293340
whether34011180010563109151177223264289
and3704118001053985132
under3850118001054691138180204
which40681180010563109126164210
circumstances429211800105385580117162232263290329374413453484
the4790118001052773115
opposite4919118001054693141187219235262302
situation523511800105324975120159184201246293
can3047132001053979125
arise318613200105406583113156
where33561320010563110152177218
energy3588132001054389131156202241
expenditure3843132001054380128171217265282308354379420
is4277132001051950
higher4341132001054764111157199224
than4580132001052773112158
energy4752132001054389131156202240
delivery.5007132001054789107124163205230271281
Such5303132001054186124170
a54881320010539
situation304714600105335076123162187205251298
does3362146001054895138170
not3550146001054793119
allow368714600105405875121184
more38881460010573119145186
than4092146001052773112158
very4268146001054081106148
short-term4433146001053379125151180204230271296368
cardiac4818146001054079104151168207246
function5081146001052370117155184202248295
and5393146001054087134
leads304716000105196199147178
inevitably3247160001051864107146164191230278296335
to3603160001052772
cardiac3697160001053979104150168206245
arrest.396416000105406591132164191207
To4192160001054182
analyze4296160001054086125143181218259
the4577160001052774116
model,47151600010572118167209227241
the4977160001052874116
influence511516000105186487108153196242281321
of5458160001054770
individual3047174001051864111128167185232277316333
independent3395174001051864111153200243289336378423449
model38581740010571118166207225
variables4097174001054079104122160207226268299
on4411174001054692
energies,4518174001054288130155201218260291306
pressures4838174001054974115147178223248288320
and5172174001054086133
stroke531917400105336085130167208
volume3047188001054085103148219261
was33231880010563103134
assessed,3472188001053971103145177208250298312
and3799188001054086133
global3946188001054865111159199217
sensitivity4177188001053375121152169195213252270296337
analysis4528188001054086125143181213230261
was48031880010563103134
performed4952188001054891116141187212283326374
using534018800105477895140188
Sobol3047202001054187136183201
indices.3264202001051864112129168208241256
Simulations3536202001054057128174192230256274320367398
of3950202001054769
syncopal4035202001053372119158203251291309
episodes4359202001054390108140186234277309
were46832020010564105131172
performed4870202001054992117142188214286328376
for526220200105236994
individuals53722020010518641121293047216001054058105150189206237
with3298216001056482108154
a34662160010540
normal3521216001054793118190229246
aortic3782216001053986111140158196
valve399221600105407997136177
and4184216001053985132
with4331216001056381107153
severe4499216001053375113155179220
AS.4734216001055192107
Four4855216001054186132157
scenarios5026216001053371112158197221239285317
were53572160010564105130171
assessed:3047230001054072104146178210252300314
resting337823000105266799127144190238
state,3633230001053260100125166180
isolated382923000105195096115154179220268
pronounced4114230001054974119166213259305344385433
reduction4564230001052667115161199228246292339
in4920230001051864
total500123000105277298137155
peripheral5173230001054891117135182229271296336354
resistance3047244001052668101119150179219266306347
(TPR),3419244001052368113156179192
TPR3635244001054287131
reduction3790244001052769118164204233251298346
with4160244001056583110158
compensatory4342244001054086159207251298330371397443469511
response,4878244001052668101149197245277320334
and5237244001054087136
TPR5397244001054287130
reduction3047258001052666113158196225242287333
with3394258001056380106152
concomitant3559258001053983129167211282299325364409434
bradycardia.4007258001054873112158196234273297342359397412
The4433258001054087129
model45762580010571117164206223
was48132580010563102133
validated495925800105407996113159197223263310
against5283258001053986124141186217244
published3047272001054894141159176206251293341
clinical340227200105395673118135173212229
data3645272001054886111150
to3809272001052771
ensure3894272001054288119163188229
physiological4136272001054995131163180225243289336353391430447
plausibility4597272001054967105150181197244262279296322362
and4973272001053985132
consistency.5119272001053983129160176207234274320358398408
Results:3047286001054485116160177203235249
The3309286001054087128
model34512860010571116163204221
identifies3686286001051864105150175192214231272304
states400328600105325998122162193
of4210286001054668
cardiac4291286001053977102147163201239
energetic4543286001054287129153198239265282319
imbalance,4876286001051887134172189227272310350362
wherein52522860010562108149174214230275
the3047300001052774116
energy3185300001054389131156203241
expenditure3448300001054381129172218266283310356381422
of3892300001054770
the3984300001052773116
heart4121300001054890128153183
exceeds4326300001054280118159202250281
the4629300001052774116
energy4767300001054389131156203242
delivered5030300001054891109126165207232273321
to5373300001052772
it.546730000105184560
Analysis3047314001055299139157196228246277
of3349314001054770
individual3444314001051865113131171189237283323341
independent3809314001051966114157205249296344387433459
variable4293314001054080106124163212230273
influence459031400105196688110156199246285326
indicates4941314001051865113131170210236278310
that5276314001052774114140
an5440314001054188
energy3047328001054389131156203242
imbalance3306328001051989137177195234280319359
in3683328001051965
AS3765328001055293
is3876328001051849
precipitated3943328001054874115155172220238264304330370418
by4379328001054986
low4483328001051965128
aortic4628328001054087112142159198
valve484432800105397997136178
area5039328001054065106145
(Sao),5201328001052462102148169181
low5400328001051865127
TPR,3047342001054186129146
high3217342001054865113160
left340134200105196184115
ventricular3540342001054082129155180199238284302342367
end-diastolic3931342001054390138165215233272304332377396413452
volume4408342001054086105151223266
(EDV),4698342001052364120164190203
high4925342001054865113160
end-systolic5109342001054390138165197237270298343362379418
elastance,3047356001054361100131159199245284324338
high3400356001054764111158
heart3573356001054789128153182
rate377035600105266692133
(HR),3918356001052377121143155
low4088356001051965128
arterial423135600105406594135160178217235
compliance4481356001053984155203221238277323362403
and4899356001054086134
high5048356001054764111157
coronary5220356001054084110155202241266307
vascular3047370001054080111150196214253278
resistance334237000105266799116147175215261300340
(Rcor).3700370001052366105150176197209
Global3926370001055573120168208226
sensitivity4169370001053375121153170196214253272298339
analysis4525370001054087126143182214231262
shows4805370001053278125187220
that5042370001052774113138
in5198370001051864
normal5279370001054794119191230248
aortic3047384001054086112141159198
valve326238400105408098137179
or3458384001054773
non-severe3549384001054793140167199241280322347388
AS,3955384001055293107
energy4080384001054389131157203242
balance4339384001054989107146192231271
is4628384001051950
primarily469638400105487492163202227245262301
determined5015384001054790116157182254271317360408
by5441384001054886
Rcor,3047398001054483128154164
TPR3227398001054186128
and3371398001054086134
HR,3521398001055599115
with3652398001056482108155
Rcor3823398001054483128153
being3992398001054992110156203
dominant.4211398001054894166183229268315340355
In4582398001051965
severe4663398001053375114156181222
AS4901398001055293
with5010398001056381108154
preserved5181398001054874115147189214257298346
coronary3047412001053984110155202242267308
vasodilatory3379412001054080112159207225242281307352378419
reserve,3822412001052668100143168210252265
Rcor4111412001054584129155
remains4290412001052667139178195242273
most45874120010573119151179
influential,479041200105196587108154197243269286325343357
while51714120010564111128146188
TPR,5383412001054186129145
Sao3047426001054181127
and3194426001054087134
EDV3349426001054196139
also350942600105405889135
contribute3665426001053984130156181199247293320361
significantly.404642600105335097143161183202240280326352370408419
When44854260010573120162208
coronary4714426001053984109155201240265307
vasodilation5041426001054080111158206224241280306323370416
is5478426001051849
impaired3047440001051889137177194219260309
in3371440001051965
severe3451440001053375114156181222
AS,3689440001055192107
Rcor3811440001054584128154
loses398044000105196597140172
relevance,416844000105256785127166206252291331345
and4528440001054087134
energy4678440001054289131156202241
balance4935440001054888106145191230271
depends5221440001054890138181227275306
mainly30474540010572111129175192231
on3300454001054794
Sao,3416454001054181127141
EDV,3579454001054196140149
and3750454001054087134
TPR.3906454001054186128145
Other4074454001055987133176201
variables4297454001054080105123161209227270302
have4621454001054786124166
minimal4809454001057290136153224263281
impact.5112454001051889137177216245260
The5394454001054190133
results3047468001052669103150169197232
of3305468001054771
simulation3403468001053351124172191231258277325374
of3803468001054772
syncopal3901468001053374123164210260301321
episode4248468001054393112145193243287
reveal4561468001052669110153193212
that4799468001052876117144
in4969468001051967
an5062468001054088
individual5177468001051866115134175195244291331351
with3047482001056382110157
a32204820010540
normal3276482001054794120193233251
aortic3543482001054087114144162202
valve,376148200105398098138181195
an3972482001054087
isolated407548200105185097117156183224273
profound4364482001054975121144191238285333
reduction4713482001052668117163202232250297345
in5074482001051865
TPR5155482001054186129
results5301482001052567100146165192226
in3047496001051968
energy3142496001054494139166215257
destabilization.3426496001055095129159202252272292311349392420439489538555
However,40094960010557106172217258303330342
the4379496001052877123
compensatory4529496001054188164214260309343386414462489534
response5090496001052771105156206256289335
as5452496001054176
well30475100010564106125143
as3210510001054073
the3302510001052875118
concomitant3440510001053985133172218291309336377424450
bradycardia3910510001054975116164204243283309356375414
serve4344510001053376102145187
to4551510001052773
reverse4644510001052668108150176210253
this491751000105277492124
imbalance.5061510001051990139180198238285325367381
In5462510001051866
contrast,3047524001053985133159185226259287303
only3372524001054795113152
the3546524001052875118
resting3686524001052668102130148195244
situation395252400105335178125165192210257305
is4279524001051850
energetically4351524001054390134160207250277296335376395413452
stable4825524001053361102150170213
in5060524001051865
case5147524001054080113156
of5325524001054771
AS.5418524001055193109
As3047538001055186
in3154538001051966
the3241538001052875118
normal3381538001054794121194234252
case,3655538001053980112156170
an3847538001054087
isolated395553800105195198117157184226275
profound4251538001054975121145191239286334
reduction4607538001052668117163203233251298346
in4975538001051865
TPR5062538001054086129
results5213538001052668101147166193227
in5462538001051865
energy3047552001054390134160208247
destabilization.3320552001054892125154194243262281299335377404422470518534
However,38805520010555103167210250292319330
neither4236552001054891110137185229255
compensatory4517552001053985158207251298331372399445472514
response5057552001052668102150199247279323
nor5406552001054795121
concomitant3047566001053985133172218290309336377424450
bradycardia3520566001054875115164203242283309356374414
can3956566001053980127
reverse4105566001052669108151177210254
the4381566001052774118
imbalance.4521566001051990139180198238285325367381
Conclusions:4925566001055095143183201248280298345393425440
This5387566001054190108140
study3047580001053361108157196
proposes3264580001054875121170218251294327
a36115800010540
hemodynamic-energetic3672580001054790162210259298347386458477516539584631674700747790818836876
mechanism45685800010572116156203243290308340412
to5000580001052873
explain5094580001054281130150189208255
how5369580001054795158
otherwise3047594001054774121164190257276308351
benign3419594001054993140158206254
circulatory369459400105395883122168187227253299325368
syncope4083594001053373121161207256300
can4404594001053980127
progress4553594001054875121170196238271303
to4878594001052773
cardiac4972594001054080106153172211251
arrest524459400105406693135168196
in5462594001051865
patients3047608001054888114131173219245278
with3341608001056280107153
severe3510608001053274113155180221
AS3746608001055192
and3853608001054086133
demonstrates4002608001054789160206253284312337377403444476
the4493608001052773115
plausibility4624608001054866105151182199247265283300327368
of5007608001054669
this509160800105277391122
concept.5228608001053984130169210257283299
In3047622001051966
individuals3139622001051966115134175194243290330349382
with3547622001056483111159
a37326220010540
normal3798622001054896123196237255
aortic4080622001054088115145164204
valve,4310622001054082100141184198
compensatory4535622001053985159208252300333374401447474517
mechanisms50786220010573117158205246293312344417449
can3047636001053980127
restore3195636001052668101129175201243
energetic3459636001054390133159206249277295335
balance3814636001054990108148195235277
during4111636001054895121139186235
syncope.4366636001053373122161207256300315
In4701636001051966
contrast,4787636001054085133159186226259287303
only5111636001054795113152
resting5284636001052668101130148195243
state3047650001053362103130173
is3246650001051851
energetically3323650001054391135161209253281300340381400419458
stable3808650001053362103152172215
in4050650001051866
severe4142650001053377118161187230
AS;4398650001055295109
all453365000105405978
conditions4637650001054086134183202230249297345378
involving5041650001051966105153172213232280329
low5396650001051967131
TPR3047664001054187131
are3203664001054167109
energetically3338664001054390134160208251278297337378397415454
unstable,3818664001054795127156197246265308323
regardless4167664001052668118158184231250293327360
of4552664001054871
compensatory4649664001054086159207252299332373400446472515
response.5190664001052668101150198246279323337
As3047678001055186
energy3158678001054390133159206246
imbalance3429678001051990139180199238285325367
is3821678001051850
incompatible3897678001051865105150223271312339357406425468
with4390678001056483110158
sustained4573678001053379111139180198245288337
cardiac4936678001053980105153171210250
function,5211678001052471119158188206253301316
it3047692001051846
inevitably3111692001051966109149168195236285304343
leads3473692001051861101149181
to3673692001052773
death.3764692001054891131157205221
The4003692001054190133
proposed4155692001054875121170218251294343
mechanism45176920010572115155203242289308340411
does4947692001054895139172
not5138692001054794121
require5278692001052668117163182207249
an3047706001054087
exaggerated3157706001054382122170219262288329355397446
Bezold-Jarisch3626706001054488124170190238265291331357376408448495
reflex,414470600105266891113156195212
although437970600105405886133180227276323
this472570600105277493125
reflex487370600105266891113156195
likely509170600105193774116135174
acts5288706001054080109144
as5454706001054073
a30477200010540
trigger310672000105275473121169212238
of3363720001054771
syncope.3453720001053373121161207256300314
REFERENCES30487410012357112167220281336407470524579
1.304775700853648
Dvoulety,310775700834578115153168202224258267
M.338775700835468
and346775700833269108
Sitina,3587757008333476984122154166
M.376675700835468
(2026).38467570083195286118152169180
Haemodynamic-energetic403975700834375110167205244276314346403418450468504542576597635669691706738
mechanism478975700835792124162194231246272329
of513075700833756
sudden519975700832663101140174212
cardiac5424757008331638430477670083385385117
death318076700833873105126165
in336076700831552
severe34287670083266193127149183
aortic36267670083327092116132164
stenosis:38057670083264983121159186201227239
A4060767008341
modelling411676700835796135170186201216254293
study.44247670083264987126158168
J4608767008324
Physiol.464776700833573103130145183199212
https://doi.org/10.1113/48757670083375983122149162188209244283298311349371409435468499512543570598628652
JP288423.30477770083246094127163199232267279