Ventricular-Arterial Coupling in Chronic Heart Failure.

Area of Science:

• Cardiovascular Physiology
• Heart Failure Pathophysiology

Background:

• Ventricular-arterial coupling (VAC) is an under-recognized cardiovascular phenotype in heart failure.
• Traditional assessment using effective arterial elastance (E_A) to LV end-systolic elastance (E_ES) in the pressure-volume plane has limitations, especially in heart failure with preserved ejection fraction (HFpEF).

Purpose of the Study:

• To review current approaches to assess ventricular-arterial interactions in heart failure.
• To highlight the pathophysiological and clinical implications of these interactions.

Main Methods:

• Review of established and emerging methods for assessing ventricular-arterial coupling.
• Discussion of limitations of pressure-volume loop analysis.
• Emphasis on the utility of pulsatile arterial hemodynamics and myocardial wall stress.

Main Results:

• Effective arterial elastance (E_A) is heavily influenced by vascular resistance and heart rate, limiting its standalone utility.
• Pulsatile arterial hemodynamics and time-resolved myocardial wall stress provide critical, incremental physiological information.
• Pulsatile arterial load emerges as a potential therapeutic target in HFpEF.

Conclusions:

• Current methods for assessing ventricular-arterial coupling in heart failure have significant limitations.
• Incorporating pulsatile arterial hemodynamics and myocardial wall stress assessment is crucial for a comprehensive understanding.
• Targeting pulsatile arterial load may offer new therapeutic avenues for HFpEF.