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

Research output: Contribution to journalReview articlepeer-review


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 (Ea) over end-systolic elastance (Ees) (Ea/Ees). 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 Ea/Ees 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.

Original languageEnglish
Pages (from-to)753-761
Number of pages9
JournalExpert Review of Cardiovascular Therapy
Issue number8
Publication statusPublished - 2021

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Free keywords

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


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