TY  -  JOUR
AU  -  Tona, Francesco
AU  -  Vescovo, Giovanni M.
T1  -  Ventricular-arterial coupling in heart failure: insights into gender-specific differences
PY  -  2020
Y1  -  2020-01-01
DO  -  10.1723/3297.32670
JO  -  The Italian Journal of Gender-Specific Medicine
JA  -  Ital J Gender-Specific Med
VL  -  6
IS  -  1
SP  -  15
EP  -  21
PB  -  Il Pensiero Scientifico Editore
SN  -  2612-3487
Y2  -  2026/05/18
UR  -  http://dx.doi.org/10.1723/3297.32670
N2  -  Summary. The cardiovascular function in physiological conditions depends on a complex interaction between heart performance and vascular system. To describe this situation, the term ‘elastance’ has been devised. Arterial elastance (Ea) is defined as the obstacle that the arterial system opposes to the work of the left ventricle. Ventricular elastance represents heart stiffness and is an important index of myocardial contractility. Considering the interaction between the left ventricle and the arterial system – which is called ventricular-arterial coupling (VAC) – information can be obtained about the functional status of the entire cardiovascular system. In physiological conditions, the ventricular-arterial coupling is different in males and females. This is due to the morphological and functional characteristics of the left ventricle, the elastic properties of the aortic wall and the different susceptibility of peripheral resistances to hormonal factors and vasoactive substances. In women, vessel and myocardial stiffness is even more pronounced in pathological conditions. This could explain the gender differences in the pathophysiology and the clinical presentation of heart failure. In fact, the prevalence of heart failure with reduced ejection fraction (HFrEF) is higher in men than in women. Conversely, the latter suffer from heart failure with preserved ejection fraction (HFpEF) more frequently than men, especially after menopause. This suggests that the loss of estrogens, which have an anti-fibrotic and anti-inflammatory activity, could play an important role in the genesis of heart failure in women, increasing left ventricular and vascular stiffness. Hormonal changes can also affect peripheral resistances, and therefore the cardiac load.
ER  -