Quantitative Imaging in Medicine and Surgery · Sep 30, 2026

Clinical significance of myocardial layer-specific ventricular-arterial coupling index in community populations

By Dong J, Wu L, Wang X et al.

BACKGROUND: Traditional global indices of ventricular-arterial coupling (VAC) often fail to reflect regional myocardial mechanics. The aim of this study was to establish and validate novel layer-specific artery-myocardial strain coupling indices by integrating arterial stiffness with layer-specific global circumferential strains (GCSs), and to determine the clinical significance of these layer-specific VAC indices across different age groups. METHODS: Left ventricular (LV) structural and functional parameters-including conventional indices and layer-specific GCSs for the endomyocardial, midmyocardial, and epimyocardial (GCSendo, GCSmid, and GCSepi) layers assessed via two-dimensional speckle-tracking echocardiography (2D-STE)-were analyzed in 398 community-dwelling individuals stratified by age, gender, and body mass index (BMI). Arterial stiffness was quantified using the arterial velocity pulse index (AVI). Layer-specific VAC indices were mathematically defined as the ratio of AVI to each layer's GCS (AVI/GCSendo, AVI/GCSmid, and AVI/GCSepi). Multiple linear regression analyses were performed to identify independent determinants of these coupling ratios, and receiver operating characteristic (ROC) curves were constructed to compare the diagnostic performance between novel and traditional VAC indices. RESULTS: The AVI/GCSendo, AVI/GCSmid, and AVI/GCSepi ratios progressively decreased from young to older individuals (r=-0.466, -0.453, and -0.375; all P<0.001), with no significant differences observed across gender or BMI strata. Correlation analyses revealed that all three ratios were significantly correlated with age and LV ejection fraction (LVEF); furthermore, AVI/GCSmid showed additional correlation with tissue Doppler imaging e' velocity (TDI e'), whereas AVI/GCSepi correlated with heart rate (HR). Multivariate regression confirmed that age and LVEF were independent predictors of these coupling ratios. Moreover, ROC curve analyses demonstrated that the diagnostic performance of AVI/GCSendo, AVI/GCSmid, and AVI/GCSepi significantly surpassed that of traditional VAC indices, such as ventricular-vascular coupling index (VVI), across all age strata. CONCLUSIONS: Independently determined by age and LVEF, the novel layer-specific AVI/GCS indices are significantly superior to traditional VVI in detecting age-related impairments in cardiovascular function. By revealing distinct transmural functional heterogeneity across myocardial layers, these indices offer a multidimensional framework for evaluating age-related cardiovascular functional alterations.

doi.org/10.21037/qims-2026-1167 Open access PubMed 42997790 Biomarkers