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

Abstract

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.

Ventriculo-arterial (un)coupling in septic shock: Impact of current and upcoming hemodynamic drugs

“…VA uncoupling is frequently observed in the early phase of septic shock. In the literature, the prevalence of uncoupling (e.g., defined by Ea/Ees ratio >1.36) in critically ill patients varies from 25% to 85% ( 16 – 19 ) ( Figure 2 ) and is associated with higher mortality ( 18 ). Also, a trend of distortion in the Ea/Ees ratio, outcome-related, has been recently observed in a small cohort study ( 20 ).…”

“…Lowering the Ea/Ees ratio between 0.6 and 1.2—a range generally observed in healthy humans—could be a target goal ( Figure 2 ) ( 3 ). VA uncoupling can exist despite normal or subnormal blood pressure ( 16 ). Hence, sizing shock resuscitation after volume optimization solely to a 65 mmHg MAP level for all patients and regardless of any cardiac function assessment does not seem to be adequate.…”