Introduction
To describe left ventricular (LV) function comprehensively, it is crucial to characterize precisely transmitral, intraventricular and transaortic pressure–flow relations. Whereas regional pressure differences between the LV, the LV outflow tract and the aorta during ejection or between the left atrium (LA), the LV inflow tract and the LV during filling have been recognized for some time, the potential clinical importance of intraventricular pressure gradients (IVPGs) have only more recently gained attention.

In fact, any complete description of ventricular function must account for ventricular suction and IVPGs along the entire cardiac cycle. IVPGs play an important physiological role in normal LV filling and emptying and may be abolished by systolic or diastolic dysfunction. However, despite all the progress in this field, the importance of IVPGs in clinical practice remains largely undefined. Therefore we hypothesize that systolic and diastolic IVPGs, a marker of normal left ventricular function, may be related to physiological asynchrony between basal and apical myocardial segments and that they can be attenuated, lost entirely, or even reversed when ventricular filling/emptying is impaired.

Objectives Animal studies: To characterize IVPGs throughout the cardiac cycle and to correlate physiological IVPGs with global haemodynamics and with myocardial segmental asynchrony between basal and apical myocardial segments in normal, afterloaded, ischemic and failing hearts; Patient studies: To evaluate IVPGs in patients with severe aortic valve stenosis (AS) before and immediately after aortic valve replacement (AVR) and highlight their clinical implications.