Prognostic value of left ventricular-arterial coupling in elderly patients with septic shock

Yan, Jing; Zhou, Xiaoyang; Hu, Bangchuan; Gong, Shijin; Yu, Yihua; Cai, Guolong; Li, Li

doi:10.1016/j.jcrc.2017.08.017

Cited by 20 publications

(16 citation statements)

References 24 publications

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“…It was previously reported that V-A coupling has a greater dependence on Ea than Ees [11] and increased Ea was the main reason for V-A decoupling in patients with sepsis and septic shock. [5] However, this study suggests that both Ea and Ees are responsible for V-A decoupling. In this study, abnormality in the value of Ea and Ees was already seen on day 1 but the cause of these alterations appeared to be changing through the clinical course.…”

Section: Discussioncontrasting

confidence: 52%

The Chronological Demographics of Ventricular-Arterial Decoupling in Patients with Sepsis and Septic Shock: A Prospective Observational Study

Nasu¹,

Sato

Takahashi³

et al. 2022

J Intensive Care Med

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Background Ventricular-arterial coupling (V-A coupling) recently gathers attention from clinicians to evaluate the interaction between afterload and left ventricular systolic function. We aimed to describe the chronological demographics of V-A decoupling in patients with sepsis and septic shock through the clinical course. Method We conducted a single-center prospective observational study comprising adult patients with sepsis and septic shock admitted to the tertiary care hospital between 04/2017 and 03/2019. Patients’ characteristics, lab data on admission, and echocardiographic parameters including Ea and Ees on the day- 1, 2, 3, 7, and 14–28 were collected. V-A decoupling was defined as Ea/Ees ≥ 1.36. Results Seventy-one patients with sepsis or septic shock were enrolled. The prevalence of V-A decoupling was as follows; day-1: 25.4%, day-2: 23.8%, day-3: 13.3%, day-7: 18.5%, day-14–28: 30.3%, respectively. Ea was higher in patients with V-A decoupling than those without throughout the clinical course (day1; 2.8 vs. 1.8, p < 0.01, day2; 2.7 vs. 1.9, p < 0.01, day3; 2.8 vs. 2.1, p = 0.06, day7; 2.7 vs. 1.9, p = 0.02, day14-28; 2.4 vs. 1.8, p = 0.08). This increase in Ea was mainly induced by reduced stroke volume (SV) as well as high systolic blood pressure (SBP) in the earlier course of sepsis but only by increased SBP in the later course of sepsis. Ees was lower in patients with V-A decoupling than those without throughout the clinical course (day1; 1.3 vs. 2.1, p < 0.01, day2; 1.5 vs. 2.3, p < 0.01, day3; 1.6 vs. 2.3, p = 0.02, day7; 1.8 vs. 2.3, p = 0.01, day14-28; 1.2 vs. 1.9, p = 0.07). Conclusion We reported that V-A decoupling was commonly seen in patients with sepsis and septic shock. In patients with V-A decoupling, both Ea and Ees were significantly altered, but the causes of these alterations appeared to be changing over the clinical course of sepsis.

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Section: Discussioncontrasting

confidence: 52%

The Chronological Demographics of Ventricular-Arterial Decoupling in Patients with Sepsis and Septic Shock: A Prospective Observational Study

Nasu¹,

Sato

Takahashi³

et al. 2022

J Intensive Care Med

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“…Ventriculo-arterial uncoupling and impaired LV efficiency is a frequent phenomenon in septic shock ( Yan et al, 2017 ; Guarracino et al, 2019 ; Pinsky and Guarracino, 2020 ). The assessment of ventriculo-arterial coupling in these patients may help to determine the underlying mechanism of cardiovascular failure and to predict the effectiveness of the hemodynamic therapies ( Guarracino et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Dynamic Arterial Elastance During Experimental Endotoxic Septic Shock: A Potential Marker of Cardiovascular Efficiency

et al. 2020

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Dynamic arterial elastance (Ea dyn ), the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), has been suggested as a dynamic parameter relating pressure and flow. We aimed to determine the effects of endotoxic septic shock and hemodynamic resuscitation on Ea dyn in an experimental study in 18 New Zealand rabbits. Animals received placebo (SHAM, n = 6) or intravenous lipopolysaccharide (E. Coli 055:B5, 1 mg⋅kg – 1 ) with or without (EDX-R, n = 6; EDX, n = 6) hemodynamic resuscitation (fluid bolus of 20 ml⋅kg – 1 and norepinephrine for restoring mean arterial pressure). Continuous arterial pressure and aortic blood flow measurements were obtained simultaneously. Cardiovascular efficiency was evaluated by the oscillatory power fraction [%Osc: oscillatory work/left ventricular (LV) total work] and the energy efficiency ratio (EER = LV total work/cardiac output). Ea dyn increased in septic animals (from 0.73 to 1.70; p = 0.012) and dropped after hemodynamic resuscitation. Ea dyn was related with the %Osc and EER [estimates: −0.101 (−0.137 to −0.064) and −9.494 (−11.964 to −7.024); p < 0.001, respectively]. So, the higher the Ea dyn, the better the cardiovascular efficiency (lower %Osc and EER). Sepsis resulted in a reduced %Osc and EER, reflecting a better cardiovascular efficiency that was tracked by Ea dyn . Ea dyn could be a potential index of cardiovascular efficiency during septic shock.

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“…Initial management as recommended by Surviving Sepsis Campaign International (SSC) Guidelines focuses on source control, early initiate of appropriate antimicrobial therapy, restoration of tissue perfusion with uid bolus, and vasopressor for maintain tissue perfusion [2,4]. However, even early initial resuscitation, sepsis-induced cardiomyopathy still occurred [5,6]. Previous studies demonstrated that mortality of septic patients with cardiac dysfunction was higher than septic patients without cardiac dysfunction [7,8].…”

Section: Introductionmentioning

confidence: 99%

Physiologic Cardiovascular Studies in Resuscitated Normotensive Septic Shock with Persistent Hyperlactatemia.

Somboonviboon

Tiyanon

Wacharasint

2021

Preprint

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Background: To study effects of increasing vasopressor dosage and fluid resuscitation on ventriculoarterial (VA) coupling and venous return (VR)-related parameters in resuscitated normotensive septic shock patients with persistent hyperlactatemia. Methods: We performed a prospective experimental study in patients with septic shock who was admitted to medical intensive care unit and still had hyperlactatemia even received initial resuscitation to maintain mean arterial pressure (MAP) >65 mmHg. All patients received incremental dose of norepinephrine (NE) to increased MAP, then NE was titrated to baseline dosage and waited for 15 mins, then fluid bolus was given. VA coupling-related parameters [arterial elastance (Ea), left ventricular end-systolic elastance (Ees), left ventricular stroke work (SW), potential energy (PE), stroke volume (SV), and Ea/Ees], and VR-related parameters [central venous pressure (CVP), mean systemic pressure analogue (Pmsa), venous return pressure (Pvr)] were measured at 4 time points including pre-increased NE phase, post-increased NE phase, pre-fluid bolus phase, and post-fluid bolus phase. Primary outcome was average of Ea/Ees. Secondary outcomes were differences in VA coupling-related parameters and VR-related parameters between pre- vs. post- interventions.Results: All 20 patients were normotensive [MAP 74 (66-80) mmHg] with elevated blood lactate [2.7 (2.4-3.6) mmol/L] at enrollment. Average Ea/Ees was 0.89 (0.61-1.16). Compared to pre-increased NE phase, post-increased NE phase had significantly higher MAP, CVP, SV, SW, PE, Pmsa, and Pvr. Likewise, compared to pre-fluid bolus phase, post-fluid bolus raised MAP, CVP, SV, Ees, SW, Pmsa, and Pvr significantly. No difference in Ea/Ees compared between before- vs. after- received both interventions.Conclusions: In resuscitated normotensive septic shock patients with persistent hyperlactatemia, we found an average Ea/Ees of 0.89. Increasing NE dosage or fluid bolus increased most of VA coupling-related parameters and VR-related parameters, but not Ea/Ees. Further large study is warranted to validate these findings.

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Prognostic value of left ventricular-arterial coupling in elderly patients with septic shock

Cited by 20 publications

References 24 publications

The Chronological Demographics of Ventricular-Arterial Decoupling in Patients with Sepsis and Septic Shock: A Prospective Observational Study

The Chronological Demographics of Ventricular-Arterial Decoupling in Patients with Sepsis and Septic Shock: A Prospective Observational Study

Dynamic Arterial Elastance During Experimental Endotoxic Septic Shock: A Potential Marker of Cardiovascular Efficiency

Physiologic Cardiovascular Studies in Resuscitated Normotensive Septic Shock with Persistent Hyperlactatemia.

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