Left Ventricular-Arterial Coupling in Cardiovascular Health: Development, Assessment Methods, and Future Directions

Left ventricular-arterial coupling (LVAC) represents a critical physiological mechanism that characterizes the interaction between left ventricular (LV) contractility and the arterial system's resistance and elasticity. The balance within LVAC is essential for efficient energy transfer from the heart, which underpins optimal cardiovascular function. In a healthy state, the balance between LV contractility and arterial elasticity and resistance allows the heart to maintain normal circulation with minimal energy expenditure. However, with the progression of age and diseases such as atherosclerosis and hypertension, arterial stiffness increases, LV function decreases, and the LVAC balance is disrupted, leading to a significantly increased risk of cardiovascular events. This imbalance is particularly significant in patients with heart failure (HF) and coronary artery disease (CAD), where LVAC imbalance is strongly associated with increased cardiac load and decreased energy efficiency. Thus, understanding and evaluating LVAC are crucial for elucidating cardiovascular physiology and guiding therapeutic strategies for diseases such as HF, hypertension, and CAD. Methods for assessing LVAC include invasive pressure-volume loops and cardiac catheterization, as well as non-invasive techniques such as echocardiography and arterial pulse wave analysis (PWA). Despite the higher accuracy of invasive methods, non-invasive methods are commonly used in clinical practice to assess LVAC because of their lower risk. With cardiac magnetic resonance imaging (CMR) and 3D/4D imaging techniques advancing, more precise structural and functional analysis of the heart and arterial system will be possible in the future. In this review, we describe the physiological mechanisms, assessment methods, influencing factors, and clinical significance of LVAC, as well as interdisciplinary studies with biomechanics and metabolism, which provide new ideas for personalized treatment of LVAC.