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

Area of Science:

• Cardiovascular physiology
• Arteriosclerosis research
• Hemodynamics

Background:

• Arteriosclerosis affects the heart and arteries, impacting ventricular-arterial coupling (VAC), a measure of cardiovascular efficiency.
• Traditional VAC assessment uses echocardiography (Ea/Ees), but evolving methods include PWV/GLS ratio and myocardial work index.
• Cardio-metabolic risk factors detrimentally affect the aorta and left ventricle (LV), influencing arterial load and LV function.

Purpose of the Study:

• To review the hemodynamic basis of VAC.
• To discuss the clinical implications and therapeutic interventions for normalizing VAC.
• To update on arterial load's impact on LV function.

Main Methods:

• This is a narrative review based on a systematic search of PubMed.
• The review covers the hemodynamic background, clinical implications, and therapeutic interventions for VAC.
• It also summarizes the effects of risk factors on the aorta and LV.

Main Results:

• Newer methods, such as the PWV/GLS ratio, may offer superior prediction of target organ damage compared to traditional echocardiographic measures.
• Therapeutic interventions, including novel anti-diabetic drugs and optimized antihypertensive treatments, show potential in normalizing VAC.
• Understanding VAC is crucial for managing cardiovascular health in high-risk patients.

Conclusions:

• The PWV/GLS ratio may be a more effective marker for predicting outcomes than traditional echocardiographic VAC assessment.
• Optimized medical treatments can normalize VAC in high-risk individuals.
• VAC is a key indicator of global cardiovascular health and response to therapy.