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Ventricular-Arterial Coupling Derived From Proximal Aortic Stiffness and Aerobic Capacity Across the Heart Failure

Nicola Riccardo Pugliese1, Alessio Balletti1, Silvia Armenia1

  • 1Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

JACC. Cardiovascular Imaging
|September 8, 2022
PubMed

Insights

Ventricular-arterial coupling (VAC) is impaired in heart failure (HF), worsening with disease severity. Heart failure with preserved ejection fraction (HFpEF) shows poorer VAC than heart failure with reduced ejection fraction (HFrEF) when assessed by aortic arch pulsed wave velocity (aa-PWV) to global longitudinal strain (GLS) ratio.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Physiology

Background:

  • Ventricular-arterial coupling (VAC) quantifies the relationship between arterial stiffness (pulsed wave velocity [PWV]) and myocardial function (global longitudinal strain [GLS]).
  • Evaluating VAC is crucial for understanding heart failure (HF) pathophysiology.

Purpose of the Study:

  • To assess VAC across the spectrum of HF.
  • To compare VAC in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

Main Methods:

  • Introduced a Doppler-derived single-beat technique for aortic arch PWV (aa-PWV) alongside tonometry-derived carotid-femoral PWV (cf-PWV).
  • Measured PWV and GLS in healthy controls, individuals at risk for HF (stage A-B), and patients with HFpEF and HFrEF (stage C).
  • Utilized combined cardiopulmonary-echocardiography exercise stress to evaluate peak oxygen consumption and peripheral extraction.

Main Results:

  • aa-PWV was lower than cf-PWV across all groups.
  • VAC, expressed as cf-PWV/GLS, was similarly compromised in HFpEF and HFrEF.
  • VAC, expressed as aa-PWV/GLS, was more impaired in HFpEF than HFrEF.
  • VAC was significantly worse in HF stages A-B and C compared to controls.
  • Abnormal VAC correlated with reduced peak oxygen consumption and independently predicted exercise capacity.

Conclusions:

  • Abnormal VAC is linked to increased HF severity and diminished functional capacity.
  • HFpEF demonstrates a more compromised VAC than HFrEF when assessed using the aa-PWV/GLS ratio.
  • The aa-PWV/GLS ratio is a valuable indicator of exercise capacity in HF.
Abstract

Keywords:
exercise capacityheart failureheart failure with preserved ejection fraction (HFpEF)pulsed wave velocityventricular-arterial coupling (VAC)

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