Moving the Goalposts in Hypertensive Risk Assessment: The AVI/LVGLS Ratio as a Sensitive Detector of Maladaptive Ventricular-Arterial Coupling.
G, T., F, P., & M, M. (2026). Moving the Goalposts in Hypertensive Risk Assessment: The AVI/LVGLS Ratio as a Sensitive Detector of Maladaptive Ventricular-Arterial Coupling.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70558
G T, F P, M M. Moving the Goalposts in Hypertensive Risk Assessment: The AVI/LVGLS Ratio as a Sensitive Detector of Maladaptive Ventricular-Arterial Coupling.. Echocardiography (Mount Kisco, N.Y.). 2026; doi: 10.1111/echo.70558
G T, F P, M M. Moving the Goalposts in Hypertensive Risk Assessment: The AVI/LVGLS Ratio as a Sensitive Detector of Maladaptive Ventricular-Arterial Coupling.[J]. Echocardiography (Mount Kisco, N.Y.). 2026. DOI: 10.1111/echo.70558.
@article{g2026,
author = {Trimarchi G and Pizzino F and Mariani M},
title = {Moving the Goalposts in Hypertensive Risk Assessment: The AVI/LVGLS Ratio as a Sensitive Detector of Maladaptive Ventricular-Arterial Coupling.},
journal = {Echocardiography (Mount Kisco, N.Y.)},
year = {2026},
doi = {10.1111/echo.70558},
note = {PMID: 42433118},
}
TY - JOUR AU - Trimarchi G AU - Pizzino F AU - Mariani M TI - Moving the Goalposts in Hypertensive Risk Assessment: The AVI/LVGLS Ratio as a Sensitive Detector of Maladaptive Ventricular-Arterial Coupling. T2 - Echocardiography (Mount Kisco, N.Y.) PY - 2026 DO - 10.1111/echo.70558 AN - PMID:42433118 ER -
PURPOSE: This commentary discusses the AVI/LVGLS ratio as an emerging, fully non-invasive marker of ventricular-arterial coupling (VAC) for refining cardiovascular risk assessment in hypertension beyond conventional indices such as left ventricular ejection fraction and Ea/Ees. METHODS: We critically appraised the study by Zhang et al., which evaluated the association between the arterial velocity-pulse index to left ventricular global longitudinal strain ratio and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk in hypertensive patients. The commentary integrates these findings with prior evidence on arterial stiffness, myocardial deformation, and VAC assessment. RESULTS: Zhang et al. showed that AVI/LVGLS differed significantly between hypertensive patients and normotensive controls and was independently associated with elevated estimated 10-year ASCVD risk. An AVI/LVGLS ratio below the fifth percentile predicted high ASCVD risk after multivariable adjustment, while the composite index demonstrated better discrimination than AVI, LVGLS, or conventional ventricular-vascular index alone. These findings support the incremental value of combining vascular load and myocardial deformation into a single echocardiography-compatible parameter. CONCLUSION: AVI/LVGLS may provide a practical bridge between vascular and myocardial phenotyping in hypertension, offering a sensitive marker of maladaptive VAC and subclinical cardiovascular risk. Prospective, multicenter validation is required before implementation in routine risk stratification or therapeutic monitoring.