Ventricular-arterial coupling: definition, pathophysiology and therapeutic targets in cardiovascular disease

ABSTRACT

Introduction

The heart and arterial system are equally affected by arteriosclerosis/atherosclerosis. There is a constant interaction between the left ventricular (LV) function and the arterial system, termed ventricular-arterial coupling (VAC), which reflects the global cardiovascular efficiency. VAC is traditionally assessed by echocardiography as the ratio of effective arterial elastance (E_a) over end-systolic elastance (E_es) (E_a/E_es). However, the concept of VAC is evolving and new methods have been proposed such as the ratio of pulse wave velocity (PWV) to global longitudinal strain (GLS) and myocardial work index.

Area covered

This clinical review presents the hemodynamic background of VAC, its clinical implications and the impact of therapeutic interventions to normalize VAC. The review also summarizes the detrimental effects of cardio-metabolic risk factors on the aorta and LV, and provides an update on arterial load and its impact on LV function. The narrative review is based upon a systemic search of the bibliographic database PubMed for publications on VAC.

Expert opinion

Newer methods such as PWV/GLS-ratio may be a superior marker of VAC than the traditional echocardiographic E_a/E_es in predicting target organ damage and its association with clinical outcomes. Novel anti-diabetic drugs and optimal antihypertensive treatment may normalize VAC in high-risk patients.

KEYWORDS:

• Arterial load
• diabetes
• global longitudinal strain
• pulse wave velocity
• systolic left ventricular function
• ventricular-arterial coupling

Article highlights

• Ventricular-arterial coupling (VAC) is the continuous interaction between the LV function and the arterial system, and is a maker of global cardiovascular performance.

• The ratio of pulse wave velocity (PWV) to global longitudinal strain (GLS) and myocardial work index derived from the pressure–GLS loop are novel methods for assessment of VAC.

• The PWV/GLS ratio has been shown better correlation with subclinical target organ damage compared with the traditional echocardiographic method (Ea/Ees).

• PWV/GLS should be further studied and validated in clinical and epidemiological studies to show its superiority in terms of clinical usefulness and prognostic value over the traditional echocardiographic method (Ea/Ees).

• Novel anti-diabetic drugs such as Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i), as well as optimal antihypertensive treatment may normalize VAC in high-risk patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in, or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by grants from the Research Council and the Heart- and Lung Foundation of Sweden to PM Nilsson. There are no conflicts of interest to report for other authors.