Key result
Ventricular-arterial decoupling occurs in ~25% of day-1 sepsis patients, driven primarily by increased arterial elastance.
Why the study?
Ventricular-arterial coupling is gaining attention as a load-independent indicator of left ventricular systolic function, but its chronological demographics through the clinical course of sepsis and septic shock required characterization.
Does ventricular-arterial decoupling alter clinical outcomes and chronological echocardiographic parameters in patients with sepsis and septic shock?
Observational (n=71)
No
Does ventricular-arterial decoupling alter clinical outcomes and chronological echocardiographic parameters in patients with sepsis and septic shock?
Ventricular-arterial decoupling is common in sepsis and septic shock, driven by both increased arterial elastance and decreased ventricular elastance, and is associated with prolonged ICU stay.
V-A decoupling may prolong ICU stay in sepsis; leaves open whether it independently drives outcomes or warrants targeted therapy.
Background: Ventricular-arterial coupling (V-A coupling) recently gathers attention from clinicians as a load-independent indicator of 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). Increased SBP and the estimated normalized ventricular elastance were responsible for this reduction of Ees. 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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Nasu et al. (2022) conducted an observational in Sepsis and septic shock (n=71). Ventricular-arterial decoupling vs. No ventricular-arterial decoupling was evaluated on Arterial elastance (Ea) on day 1 (p=<0.01). Ventricular-arterial decoupling occurred in 25.4% of patients with sepsis and septic shock on day 1, driven by both significantly increased arterial elastance and decreased end-systolic elastance.
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