Ventricular-Arterial Coupling in Heart Failure with Preserved Ejection Fraction: A Bibliometric Review and Clinical Implications.

Abstract

Heart failure remains a growing global health burden, and early disruptions in ventricular-arterial coupling (VAC) contribute to its pathogenesis, particularly in heart failure with preserved ejection fraction (HFpEF). We conducted an integrative bibliometric and thematic review of Web of Science records (search on 1 March 2025; coverage through December 2024) to map how VAC has evolved from a mechanistic construct to a clinically actionable framework in HFpEF. Output accelerated since 2006, with four core clusters spanning haemodynamics, right ventricle- pulmonary artery coupling, arterial stiffness, and clinical imaging. VAC has steadily moved physiological constructs toward clinical risk stratification, especially in HFpEF and right ventricular dysfunction. Important gaps include non-standardised assessment and limited prospective validation of VAC-targeted interventions. This review synthesises mechanistic and clinical evidence across the left atrial, left ventricular, and right ventricle-pulmonary artery axes and, on that basis, sets practical priorities for measurement standardisation and prospective validation within a whole-heart perspective.