The assessment of arterial stiffness, a common feature of ageing, exacerbated by many common disorders such as hypertension, diabetes mellitus, or renal diseases, has become an attractive tool for identifying structural and functional abnormalities of the arteries in the preclinical stages of the atherosclerotic disease. Arterial stiffness has been recognized as an important pathophysiological determinant of systolic blood pressure and pulse pressure increases and therefore the cause of cardiovascular complications, demonstrating also an independent predictive value for cardiovascular events. Although there are many techniques and indices currently available, their large clinical application is limited by a lack of standardization, with important difficulties when one try effectively to measure, quantify, and compare. Moreover, information on the 'heart-vessel coupling disease', in which combined stiffness of both heart and arteries interact to limit cardiovascular performance and its possible implications in different clinical conditions, is still not well known. We overviewed main methods and indices used to estimate arterial stiffness and aimed to provide an insight into the knowledge of the ventricular-arterial coupling from the cardiologist's point of view.

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The interplay between cardiac function and arterial system, which in turn affects ventricular performance, is defined commonly ventricular-arterial coupling and is an expression of global cardiovascular efficiency. This relation can be expressed in mathematical terms as the ratio between arterial elastance (EA) and end-systolic elastance (EES) of the left ventricle (LV). The noninvasive calculation requires complicated formulae, which can be, however, easily implemented in computerized algorithms, allowing the adoption of this index in the clinical evaluation of patients. This review summarizes the up-to-date literature on the topic, with particular focus on the main clinical studies, which range over different clinical scenarios, namely hypertension, heart failure, coronary artery disease, and valvular heart disease.