Validation of Stroke Work and Ventricular Arterial Coupling as Markers of Cardiovascular Performance during Resuscitation

Martin, R; Norris, Pippa; Kilgo, Patrick D.; Miller, Preston R.; Hoth, J. Jason; Meredith, J. Wayne; Chang, Michael; Morris, John A.

doi:10.1097/01.ta.0000217943.72465.52

Cited by 18 publications

(7 citation statements)

References 18 publications

(18 reference statements)

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“…To the best of our knowledge, this is the first attempt that has specifically focused on VO 2 . Previous authors have studied the association of V-A coupling improvement and the time course of systemic oxygenation parameters in trauma patients (26,27). Our results support their findings by demonstrating an association between V-A coupling, SW/PVA ratio, to perfusion parameters and further VO 2 changes.…”

Section: Clinical Relevance Of V-a Coupling In Icu Patientssupporting

confidence: 89%

Ventriculo-arterial uncoupling is associated with VO₂dependency in cardiac surgical patients

Guinot

Nguyen

Huette³

et al. 2019

Preprint

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Background:The clinical relevance of V-A (un)coupling in critically ill patients is under investigation. In this study we measured the association between V-A coupling and oxygen consumption (VO 2 ) response in patients with acute circulatory instability following cardiac surgery. Methods and results:Sixty-one cardio-thoracic ICU patients who received fluid challenge or norepinephrine infusion were included. Arterial pressure, cardiac output (CO), heart rate (HR), arterial (E A ), and ventricular elastances (E V ), total indexed peripheral resistance (TPRi) were assessed before and after hemodynamic interventions. VO 2 responders were defined as VO 2 increase > 15 %. V-A coupling was evaluated by the ratio E A /E V. Left ventricle stroke work (SW) to pressure volume area (PVA) ratio was calculated. In the overall population, 24 patients (39%) were VO 2 responders and 48 patients were uncoupled (i.e., E A /E V ratio > 1.3): 1.9 (1.6-2.4). Most of the uncoupled patients were classified as VO 2 responders (28 of 31 patients, p=0.031). Changes in VO 2 were correlated with those of TPRi, E A , E A /E V and CO. E A /E V ratio predicted VO 2 increase with an AUC of 0.76 [95 % CI: 0.62-0.87]; p=0.001. In multivariate and principal component analyses, E A /E V and SW/PVA ratios were independently associated (P < 0.05) with VO 2 response following interventions. Conclusions: VO 2 responders were characterized by baseline V-A uncoupling due to high E A and low E V . Baseline E A /E V and SW/PVA ratios were associated with VO 2 changes independently of the hemodynamic intervention used. These results further underline the pathophysiological significance of V-A uncoupling in patients with hemodynamic instability.

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Section: Clinical Relevance Of V-a Coupling In Icu Patientssupporting

confidence: 89%

Ventriculo-arterial uncoupling is associated with VO₂dependency in cardiac surgical patients

Guinot

Nguyen

Huette³

et al. 2019

Preprint

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“…Recently, Martin et al . demonstrated a better prognosis in patients with polytrauma using LV stroke work and ventriculoarterial coupling as targets of therapy [22]. …”

Section: Discussionmentioning

confidence: 99%

Ventriculoarterial decoupling in human septic shock

et al. 2014

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IntroductionSeptic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive cardiovascular state associated with multiorgan dysfunction and metabolic disturbances. Management of septic shock is targeted at preserving adequate organ perfusion pressure without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction often occurs in septic shock patients and can significantly affect outcomes. One physiologic approach to detect the interaction between the heart and the circulation when both are affected is to examine ventriculoarterial coupling, which is defined by the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees). In this study, we analyzed ventriculoarterial coupling in a cohort of patients admitted to ICUs who presented with vs without septic shock.MethodsIn this retrospective cross-sectional opportunity study, we measured routine hemodynamics using indwelling arterial and pulmonary arterial catheters and transthoracic echocardiograms in 25 septic patients (group S) and 25 non–septic shock patients (group C) upon ICU admission. Ees was measured by echocardiography using a single-beat (EesSB) method. Ea was calculated as 0.9 systolic arterial pressure/stroke volume, and then the Ea/EesSB ratio was calculated (normal value <1.36).ResultsIn group S, 21 patients had an Ea/EesSB ratio >1.36 (uncoupled). The four patients with Ea/EesSB ratios ≤1.36 had higher EesSB values than patients with Ea/EesSB ratios >1.36 (P = 0.007), although Ea measurements were similar in both groups (P = 0.4). In group C, five patients had uncoupled Ea/EesSB ratios. No correlation was found between EesSB and left ventricular ejection fraction and between Ea/EesSB ratio and mixed venous oxygen saturation in septic shock patients.ConclusionsUpon admission to the ICU, patients in septic shock often display significant ventriculoarterial decoupling that is associated with impaired left ventricular performance. Because Ea/Ees decoupling alters cardiovascular efficiency and cardiac energetic requirements independently of Ea or Ees, we speculate that septic patients with ventriculoarterial uncoupling may benefit from therapy aimed at normalizing the Ea/Ees ratio.

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“…The use of invasive monitoring, such as the central venous pressure (CVP) or pulmonary artery catheter (PAC) theoretically should help, especially in the elderly, but studies do not support their use. [53][54][55][56] One study suggests that the CVP is influenced more by intraabdominal pressures than actual right atrial pressures. 57 Pulmonary artery catheters (PAC) have the capability to provide more information, but recent studies suggest that the PAC does not change mortality in other diseases.…”

Section: Endpoints Of Resuscitationmentioning

confidence: 99%

“…57 Pulmonary artery catheters (PAC) have the capability to provide more information, but recent studies suggest that the PAC does not change mortality in other diseases. [53][54][55][56] Invasive monitors continue to become more sophisticated. Pulmonary artery catheters have the capability of measuring continuous cardiac output and mixed venous oxygen saturation.…”

Section: Endpoints Of Resuscitationmentioning

confidence: 99%

Burn Resuscitation

Greenhalgh

2007

Journal of Burn Care & Research

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Validation of Stroke Work and Ventricular Arterial Coupling as Markers of Cardiovascular Performance during Resuscitation

Abstract: Previous work demonstrating the use of SWI and VAC as resuscitation guidelines was supported through the use of a powerful ICU data management system (SIMON). The emergence of these "new vital signs" may change the way injured patients are evaluated and resuscitated in the ICU.

Cited by 18 publications

References 18 publications

Ventriculo-arterial uncoupling is associated with VO₂dependency in cardiac surgical patients

Ventriculo-arterial uncoupling is associated with VO₂dependency in cardiac surgical patients

Ventriculoarterial decoupling in human septic shock

Burn Resuscitation

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Validation of Stroke Work and Ventricular Arterial Coupling as Markers of Cardiovascular Performance during Resuscitation

Abstract: Previous work demonstrating the use of SWI and VAC as resuscitation guidelines was supported through the use of a powerful ICU data management system (SIMON). The emergence of these "new vital signs" may change the way injured patients are evaluated and resuscitated in the ICU.

Cited by 18 publications

References 18 publications

Ventriculo-arterial uncoupling is associated with VO2dependency in cardiac surgical patients

Ventriculo-arterial uncoupling is associated with VO2dependency in cardiac surgical patients

Ventriculoarterial decoupling in human septic shock

Burn Resuscitation

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Product

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Ventriculo-arterial uncoupling is associated with VO₂dependency in cardiac surgical patients

Ventriculo-arterial uncoupling is associated with VO₂dependency in cardiac surgical patients