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. 2025 May 30;12(6):208.
doi: 10.3390/jcdd12060208.

Higher Physical Activity Is Associated with Improved Ventricular-Arterial Coupling: Assessment Using the cfPWV/GLS Ratio in Primary Care-A Pilot Study

Paula-Anca Sulea  1   2 , Ioan Tilea  2 , Florin Stoica  1   2 , Liviu Cristescu  1 , Diana-Andreea Moldovan  1   3 , Radu Tatar  1   2 , Raluca-Maria Tilinca  4 , Razvan Gheorghita Mares  2 , Andreea Varga  3
Affiliations

Higher Physical Activity Is Associated with Improved Ventricular-Arterial Coupling: Assessment Using the cfPWV/GLS Ratio in Primary Care-A Pilot Study

Paula-Anca Sulea et al. J Cardiovasc Dev Dis. .

Abstract

Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular-arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid-femoral pulse wave velocity to global longitudinal strain (cfPWV/GLS) ratio, in a Romanian primary care cohort.

Methods: The prospective cohort analysis was performed on 81 adults (49 females, mean age 50.27 ± 12.93 years). Physical activity was quantified through anamnesis using metabolic equivalents (METs) according with Compendium of Physical Activities, and patients were stratified into four groups: G1 (METs < 1.5, n = 39), G2 (METs = 1.5-2.9, n = 2), G3 (METs = 3-5.9, n = 23), and G4 (METs ≥ 6, n = 17). Demographic and echocardiographic data were recorded to explore associations between physical activity and VAC.

Results: The cfPWV/GLS ratio differed significantly across groups (p = 0.012), with the lowest values present in the moderate-intensity group (G3). VAC ≥ 0.391 can predict sedentary lifestyles (AUC = 0.730; CI: 0.617-0.833, p > 0.001). Multivariate analysis revealed that age, arterial age, and hypertension independently predict VAC.

Conclusions: Higher physical activity is inversely associated with VAC (cfPWV/GLS ratio) and can predict sedentary lifestyles. Encouraging moderate-to-vigorous exercise in primary care may improve cardiovascular function and aid prevention.

Keywords: cardiovascular risk; carotid–femoral pulse wave velocity; global longitudinal strain; metabolic equivalents; vascular stiffening; ventricular–arterial coupling.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Box plot of VAC across patient groups stratified according to METs. cfPWV, carotid–femoral pulse wave velocity; GLS, global longitudinal strain; G1, group 1; G2, group 2; G3, group 3; G4, group 4; VAC, ventricular–arterial coupling, expressed as the ratio between cfPWV and average GLS.
Figure 2
Figure 2
Comparison of ROC curves for identifying sedentary individuals. AUC, area under the curve; cfPWV, carotid–femoral pulse wave velocity; Ea, effective arterial elastance; Ees, left ventricular end-systolic elastance; GLS, global longitudinal strain; VAC, ventricular–arterial coupling.
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