Moving the Goalposts in Hypertensive Risk Assessment: The AVI/LVGLS Ratio as a Sensitive Detector of Maladaptive Ventricular-Arterial Coupling

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.