Response to Letter Regarding Article, “Cardiac Structure and Ventricular–Vascular Function in Persons With Heart Failure and Preserved Ejection Fraction From Olmsted

We appreciate the comments of Tartière et al on our study1 and agree that these are valid concerns about the noninvasive estimation of systolic vascular and ventricular stiffness. As acknowledged in our paper, “Although total vascular load and indirect measures of vascular stiffness were obtained here, further study is needed to evaluate more direct and perhaps regional measures of vascular stiffening and other assessments of arterial impedance and its impact such as characteristic impedance, wave reflections, and pulse-wave velocity. ” Whereas effective arterial elastance, derived from the ratio of end-systolic pressure to stroke volume, is a useful index of total vascular load which, importantly, can be linked to measures of ventricular elastance in the assessment of vascular–ventricular cou-pling, there remains concern that arterial systems with very marked systolic wave reflections and wave transmission effects may be inadequately represented by this parameter. In the human validatio