Key result
Ventriculoarterial coupling assessment using noninvasive echocardiography and arterial pressure monitoring predicts cardiovascular response to resuscitation and outcome in septic patients.
Why the study?
To highlight the role of ventriculoarterial coupling in the pathophysiology of sepsis and how to assess it.
How can ventriculoarterial coupling be assessed and what is its role in the pathophysiology of sepsis?
How can ventriculoarterial coupling be assessed and what is its role in the pathophysiology of sepsis?
Noninvasive bedside assessment of ventriculoarterial coupling using echocardiography and arterial pressure monitoring can guide resuscitation and predict outcomes in septic patients.
Assessment of ventriculoarterial coupling may refine sepsis resuscitation; leaves open prospective trials to confirm outcome benefit.
PURPOSE OF REVIEW: We will highlight the role of ventriculoarterial coupling in the pathophysiology of sepsis and how to assess it. RECENT FINDINGS: Most septic patients show a ventriculoarterial uncoupling at the time of diagnosis with arterial elastance (Ea) greater than left ventricle (LV) end-systolic elastance (Ees), often despite arterial hypotension. Ventriculoarterial coupling levels predict the cardiovascular response to resuscitation in this heterogeneously responding population. SUMMARY: Ventriculoarterial coupling is quantified as the ratio of Ea to Ees. The efficiency of the cardiovascular function is optimal when Ea/Ees is near one. When the hydraulic load of the arterial system is excessive either from increased vasomotor tone, decreased LV contractility or both, Ea/Ees becomes greater than 1 (i.e. ventriculoarterial decoupling), and cardiac efficiency decreases leading to heart failure, loss of volume responsiveness, and if sustained, increased mortality. Noninvasive echocardiographic techniques when linked with arterial pressure monitoring allow for the bedside estimates of both Ea and Ees. Studies using this approach have documented the key role ventriculoarterial coupling has defining initial cardiovascular state, response to therapy and outcome from critical illness. Sequential monitoring of ventriculoarterial coupling at the bedside offers a unique opportunity to assess relevant cardiovascular determinants in septic patients requiring resuscitation.
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Pinsky et al. (2020) conducted a review in sepsis. Ventriculoarterial coupling assessment was evaluated. Ventriculoarterial coupling assessment using noninvasive echocardiography and arterial pressure monitoring predicts cardiovascular response to resuscitation and outcome in septic patients.
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