Abstract:IntroductionThe determination of ventriculo-arterial coupling is gaining an increasing role in cardiovascular and sport medicine. However, its relevance in critically ill patients is still under investigation. In this study we measured the association between ventriculo-arterial coupling and oxygen consumption (VO2) response after hemodynamic interventions in cardiac surgery patients with acute circulatory instability.Material and MethodsSixty-one cardio-thoracic ICU patients (67 ± 12 years, 80% men) who recei… Show more
“…This study was a retrospective analysis of a prospectively collected observational database for studying the ventriculo-arterial coupling in the ICU ( 5 ). All patients received written information and provided their consent to participate.…”
Section: Methodsmentioning
confidence: 99%
“…Targeting ventriculo-arterial coupling is a promising approach in patients with cardiocirculatory failure ( 1 – 3 ), because of its intrinsic connection with myocardium energetics and cardiovascular efficiency ( 4 , 5 ). Ventriculo-arterial coupling is an integrative concept that numerically encompasses the volume/pressure interaction of the left ventricle (LV) with the arterial system, being described as the ratio between the global arterial elastance (E A ) and left ventricular elastance (E V ) ( 3 , 6 ).…”
IntroductionTwo parallel paradigms of cardiovascular efficiency and haemodynamic optimisation coexist in haemodynamic research. Targeting ventriculo-arterial (VA) coupling [i.e., the ratio between arterial and ventricular elastance (EV)] and electromechanical coupling are two promising approaches in acute circulatory failure. However, validation of the parameters of electromechanical coupling in critically ill patients is ongoing. Furthermore, a unifying link between VA and electromechanical coupling may exist, as EV is correlated with different times of the cardiac cycle.Materials and MethodsThis study was a retrospective analysis of a prospectively collected observational database from one tertiary center ICU. We analyzed the relationship between electromechanical dyssynchrony and acute circulatory failure hemodynamics before and after treatment (i.e., fluid expansion, dobutamine, or norepinephrine infusion). The relationship between electromechanical coupling and VA coupling was also investigated. Adult patients with haemodynamic instability were included. Haemodynamic parameters, including arterial pressure, cardiac index, VA coupling, stroke work index/pressure–volume area (SWI/PVA), t-IVT, and Tei's index, were collected before and after treatment. A t-IVT of >12 s/min was classified as intraventricular dyssynchrony.ResultsWe included 54 patients; 39 (72.2%) were classified as having intraventricular dyssynchrony at baseline. These patients with baseline dyssynchrony showed a statistically significant amelioration of t-IVT (from 18 ± 4 s to 14 ± 6 s, p = 0.001), left ventricular EV [from 1.1 (0.72–1.52) to 1.33 (0.84–1.67) mmHg mL−1, p = 0.001], VA coupling [from 2 (1.67–2.59) to 1.80 (1.40–2.21), p = 0.001], and SWI/PVA [from 0.58 (0.49–0.65) to 0.64 (0.51–0.68), p = 0.007]. Patients without baseline dyssynchrony showed no statistically significant results. The improvement in VA coupling was mediated by an amelioration of EV. All patients improved their arterial pressure and cardiac index with treatment. The haemodynamic treatment group exhibited no effect on changing t-IVT.ConclusionAcute circulatory failure is associated with electromechanical dyssynchrony. Cardiac electromechanical coupling was improved by haemodynamic treatment only if altered at baseline. The improvement of cardiac electromechanical coupling was associated with the improvement of markers of cardiocirculatory efficacy and efficiency (i.e., SWI/PVA and VA coupling). This study was the first to demonstrate a possible link between cardiac electromechanical coupling and VA coupling in patients with acute circulatory failure.
“…This study was a retrospective analysis of a prospectively collected observational database for studying the ventriculo-arterial coupling in the ICU ( 5 ). All patients received written information and provided their consent to participate.…”
Section: Methodsmentioning
confidence: 99%
“…Targeting ventriculo-arterial coupling is a promising approach in patients with cardiocirculatory failure ( 1 – 3 ), because of its intrinsic connection with myocardium energetics and cardiovascular efficiency ( 4 , 5 ). Ventriculo-arterial coupling is an integrative concept that numerically encompasses the volume/pressure interaction of the left ventricle (LV) with the arterial system, being described as the ratio between the global arterial elastance (E A ) and left ventricular elastance (E V ) ( 3 , 6 ).…”
IntroductionTwo parallel paradigms of cardiovascular efficiency and haemodynamic optimisation coexist in haemodynamic research. Targeting ventriculo-arterial (VA) coupling [i.e., the ratio between arterial and ventricular elastance (EV)] and electromechanical coupling are two promising approaches in acute circulatory failure. However, validation of the parameters of electromechanical coupling in critically ill patients is ongoing. Furthermore, a unifying link between VA and electromechanical coupling may exist, as EV is correlated with different times of the cardiac cycle.Materials and MethodsThis study was a retrospective analysis of a prospectively collected observational database from one tertiary center ICU. We analyzed the relationship between electromechanical dyssynchrony and acute circulatory failure hemodynamics before and after treatment (i.e., fluid expansion, dobutamine, or norepinephrine infusion). The relationship between electromechanical coupling and VA coupling was also investigated. Adult patients with haemodynamic instability were included. Haemodynamic parameters, including arterial pressure, cardiac index, VA coupling, stroke work index/pressure–volume area (SWI/PVA), t-IVT, and Tei's index, were collected before and after treatment. A t-IVT of >12 s/min was classified as intraventricular dyssynchrony.ResultsWe included 54 patients; 39 (72.2%) were classified as having intraventricular dyssynchrony at baseline. These patients with baseline dyssynchrony showed a statistically significant amelioration of t-IVT (from 18 ± 4 s to 14 ± 6 s, p = 0.001), left ventricular EV [from 1.1 (0.72–1.52) to 1.33 (0.84–1.67) mmHg mL−1, p = 0.001], VA coupling [from 2 (1.67–2.59) to 1.80 (1.40–2.21), p = 0.001], and SWI/PVA [from 0.58 (0.49–0.65) to 0.64 (0.51–0.68), p = 0.007]. Patients without baseline dyssynchrony showed no statistically significant results. The improvement in VA coupling was mediated by an amelioration of EV. All patients improved their arterial pressure and cardiac index with treatment. The haemodynamic treatment group exhibited no effect on changing t-IVT.ConclusionAcute circulatory failure is associated with electromechanical dyssynchrony. Cardiac electromechanical coupling was improved by haemodynamic treatment only if altered at baseline. The improvement of cardiac electromechanical coupling was associated with the improvement of markers of cardiocirculatory efficacy and efficiency (i.e., SWI/PVA and VA coupling). This study was the first to demonstrate a possible link between cardiac electromechanical coupling and VA coupling in patients with acute circulatory failure.
“…The concept of ventriculo-arterial coupling may be used to clinically assess the patient's cardiovascular condition under VA ECMO and has been reported for different cardiovascular diseases, but deserves more experimental and clinical analyses. 42,43 From a clinical perspective, it should be noted that bedside use of E A and E ES is not a widespread routine but can be conducted using echocardiography and invasive arterial blood pressure monitoring. 42 In analogy to left-sided ventriculo-arterial coupling, right-sided ventriculo-pulmonary arterial coupling and right-left ventricular interaction or interdependence are also important physiological concepts that affect daily management of VA ECMO.…”
Section: Right and Left Ventriculo-arterial Coupling And Interdependencementioning
confidence: 99%
“…The concept of ventriculo-arterial coupling may be used to clinically assess the patient’s cardiovascular condition under VA ECMO and has been reported for different cardiovascular diseases, but deserves more experimental and clinical analyses. 42,43 From a clinical perspective, it should be noted that bedside use of E A and E ES is not a widespread routine but can be conducted using echocardiography and invasive arterial blood pressure monitoring. 42 Figure 2.Schematic representation of pressure-volume loops of the left ventricle during baseline (Healthy), heart failure and heart failure supported with different blood flows provided by venoarterial extracorporeal membrane oxygenation (ECMO).…”
Section: Cardiac Function and Loadingmentioning
confidence: 99%
“…The concept of ventriculo-arterial coupling may be used to clinically assess the patient’s cardiovascular condition under VA ECMO and has been reported for different cardiovascular diseases, but deserves more experimental and clinical analyses. 42 , 43 From a clinical perspective, it should be noted that bedside use of E A and E ES is not a widespread routine but can be conducted using echocardiography and invasive arterial blood pressure monitoring. 42 Figure 2.…”
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become a standard of care for severe cardiogenic shock, refractory cardiac arrest and related impending multiorgan failure. The widespread clinical use of this complex temporary circulatory support modality is still contrasted by a lack of formal scientific evidence in the current literature. This might at least in part be attributable to VA ECMO related complications, which may significantly impact on clinical outcome. In order to limit adverse effects of VA ECMO as much as possible an indepth understanding of the complex physiology during extracorporeally supported cardiogenic shock states is critically important. This review covers all relevant physiological aspects of VA ECMO interacting with the human body in detail. This, to provide a solid basis for health care professionals involved in the daily management of patients supported with VA ECMO and suffering from cardiogenic shock or cardiac arrest and impending multiorgan failure for the best possible care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
