Arterial stiffness and vascular load in heart failure.

Vascular load is an important determinant of ventricular function. This is particularly true of the failing heart, which is exquisitely load-sensitive. Vascular load comprises 2 major components: resistive load, which arises primarily at the arteriolar resistance vessels, and pulsatile load, which is primarily determined by aortic stiffness and early return of reflected waves from the periphery to the heart. Assessment of pulsatile load is gaining increasing prominence as evidence grows of a significant pathophysiologic role for arterial stiffness in cardiovascular disease, including heart failure. Assessment of arterial stiffness and vascular load is reviewed here. The importance of optimal ventricular-vascular coupling to maximize the efficiency of cardiac ejection is discussed. Current knowledge of arterial stiffness, vascular load, and ventricular-vascular coupling in systolic heart failure and in heart failure with a normal ejection fraction ("diastolic failure") is described. Reducing aortic stiffness may form an important future therapeutic target in patients with heart failure.