Ventricular–Arterial Coupling in Chronic Heart Failure

Abstract

Measures of interaction between the left ventricle (LV) and arterial system (ventricular–arterial coupling) are important but underrecognised cardiovascular phenotypes in heart failure. Ventriculo-arterial coupling is commonly assessed in the pressure–volume plane, using the ratio of effective arterial elastance (EA) to LV end-systolic elastance (EES) to provide information on ventricular–arterial system mechanical efficiency and performance when LV ejection fraction is abnormal. These analyses have significant limitations, such as neglecting systolic loading sequence, and are less informative in heart failure with preserved ejection fraction (HFpEF). EA is almost entirely dependent on vascular resistance and heart rate. Assessment of pulsatile arterial haemodynamics and time-resolved myocardial wall stress provide critical incremental physiological information and should be more widely utilised. Pulsatile arterial load represents a promising therapeutic target in HFpEF. Here, we review various approaches to assess ventricular–arterial interactions, and their pathophysiological and clinical implications in heart failure.