Arterial stiffness/elasticity plays a major role in the pathogenesis of heart failure beyond arterial blood pressure. Arterial wave reflections are generated from the periphery of the vascular system, especially at the level of the small arteries. The pattern change of the arterial wave reflections can alter the ventricular-vascular coupling in a pathologic manner, leading to heart failure. Several noninvasive techniques are used to estimate arterial stiffness/elasticity. Small artery elasticity has important predictive value for the diagnosis of heart failure. The beneficial effect of some cardiovascular therapy on arterial stiffness/elasticity has potential to prevent or delay the progression of heart failure.