Ventricular-Arterial Coupling In Severe Aortic Stenosis: Implications for Prognosis

Aortic stenosis (AS) is characterized by the narrowing of the aortic valve, restricting blood flow from the heart to the rest of the body.1 This progressive condition significantly burdens the heart, especially the left ventricle (LV), as it struggles to overcome the increased afterload. Over time, this pressure overload may lead to left ventricular hypertrophy, heart failure, and death if untreated.2 AS shares many pathological features and risk factors with atherosclerosis, and its prevalence has increased in the aging population.3 Understanding the relationship between arterial properties and ventricular-arterial coupling (VAC) in severe aortic stenosis is essential for assessing patient prognosis.4 VAC is defined by the ratio of effective arterial elastance (Ea) to end-systolic elastance (Ees). A high Ea/Ees ratio is linked to poor clinical outcomes, especially following procedures like transcatheter aortic valve replacement.5 On the other hand, the relationship between arterial properties and prognosis in cardiovascular diseases (CVDs) is influenced by several mechanisms, primarily involving arterial stiffness, endothelial dysfunction, and inflammation.6