Ventricular–arterial coupling: Invasive and non-invasive assessment

DOI

10.1016/j.artres.2012.12.002How to use a DOI?

Keywords

Ventricular-arterial coupling; Ventricular afterload; Ventricular elastance; Effective arterial elastance

Abstract

Interactions between the left ventricle (LV) and the arterial system, (ventricular–arterial coupling) are key determinants of cardiovascular function. Ventricular–arterial coupling is most frequently assessed in the pressure–volume plane using the ratio of effective arterial elastance (E_A) to LV end-systolic elastance (E_ES). E_A (usually interpreted as a lumped index of arterial load) can be computed as end-systolic pressure/stroke volume, whereas E_ES (a load-independent measure of LV chamber systolic stiffness and contractility) is ideally assessed invasively using data from a family of pressure–volume loops obtained during an acute preload alteration. Single-beat methods have also been proposed, allowing for non-invasive estimations of E_ES using simple echocardiographic measurements. The E_A/E_ES ratio is useful because it provides information regarding the operating mechanical efficiency and performance of the ventricular–arterial system. However, it should be recognized that analyses in the pressure–volume plane have several limitations and that “ventricular–arterial coupling” encompasses multiple physiologic aspects, many of which are not captured in the pressure–volume plane. Therefore, additional assessments provide important incremental physiologic information about the cardiovascular system and should be more widely used. In particular, it should be recognized that: (1) comprehensive analyses of arterial load are important because E_A poorly characterizes pulsatile LV load and does not depend exclusively on arterial properties; (2) The systolic loading sequence, an important aspect of ventricular–arterial coupling, is neglected by pressure–volume analyses, and can profoundly impact LV function, remodeling and progression to heart failure. This brief review summarizes methods for the assessment of ventricular–arterial interactions, as discussed at the Artery 12 meeting (October 2012).

Copyright

© 2013 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.

Open Access

This is an open access article distributed under the CC BY-NC license.

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TY  - JOUR
AU  - Julio A. Chirinos
PY  - 2013
DA  - 2013/01/10
TI  - Ventricular–arterial coupling: Invasive and non-invasive assessment
JO  - Artery Research
SP  - 2
EP  - 14
VL  - 7
IS  - 1
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2012.12.002
DO  - 10.1016/j.artres.2012.12.002
ID  - Chirinos2013
ER  -