Ventricular–Arterial Coupling in Chronic Heart Failure

Abstract

PathophysiologyAccess at: www.CFRjournal.comDetailed phenotyping of ventricular-arterial coupling (VAC) and systemic arterial haemodynamics provide important insights into the pathophysiology of left ventricular (LV) energetics, remodelling and fibrosis, and systolic and diastolic dysfunction in various disease states including heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). AbstractMeasures 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 (E A ) to LV end-systolic elastance (E ES ) 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). E A 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.

The Impact of Sacrubitril/Valsartan on Clinical Treatment and hs-cTnT and NT-ProBNP Serum Levels and the Left Ventricular Function in Patients with Chronic Heart Failure

“…20,21) When heart failure occurs, the tension of the left ventricular wall will increase with the increase of cardiac pressure or volume load, and this stresses cardiomyocytes. 22) This in turn causes the increased secretion of natriuretic peptide and activation of the renin-angiotensin-aldosterone system (RAAS) through neurohumoral and endocrine regulation. Neprilysin is a key enzyme in the degradation of bioactive natriuretic peptide, which can promote natriuresis and dilation of vessels.…”

Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

“…PVA -это площадь, ограниченная тремя линиями (кривой конечного диастолического давления-объема, линией конечно-систолического отношения давления-объема и систолической частью траектории контура давления-объема). PVA состоит из двух частей: внешней работы ЛЖ по выбросу (площадь в пределах траектории цикла давление-объем) и область треугольной формы, представляющая собой потенциальную энергию, которая накапливается и остается в стенке ЛЖ во время систолы [4].…”

“…Анализ петли "давление-объем". Сокращения: Ees -желудочковый эластанс, Ea -артериальный эластанс, PE -потенциальная энергия, PVA -область давление-объем, SW -внешняя работа ЛЖ [4]. и мониторинга терапевтических вмешательств.…”

Ventriculo-arterial uncoupling is associated with VO2dependency in cardiac surgical patients

“…Septic shock is characterised by different profiles of V-A uncoupling (i.e different hemodynamic profiles) for which hemodynamic treatment may differ (23). The use of beta-blockers is an illustration of hemodynamic optimisation based on V-A coupling perspective (24,25). Cardiologists have already integrated this hemodynamic approach in the treatment of chronic heart failure or arterial hypertension (9,18,25).…”

“…The use of beta-blockers is an illustration of hemodynamic optimisation based on V-A coupling perspective (24,25). Cardiologists have already integrated this hemodynamic approach in the treatment of chronic heart failure or arterial hypertension (9,18,25). Moreover, V-A coupling has been demonstrated as a factor limiting patients' adaptability to effort (8,20).…”