Ventriculo-Arterial Coupling Is Associated With Oxygen Consumption and Tissue Perfusion in Acute Circulatory Failure

{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 received hemodynamic therapeutic interventions (fluid challenge or norepinephrine infusion) were included. Arterial pressure, cardiac output, heart rate, arterial (E-A), and ventricular elastances (E-V), total indexed peripheral resistances were assessed before and after hemodynamic interventions. VO2 responsiveness was defined as VO2 increase >15% following the hemodynamic intervention. Ventriculo-arterial coupling was assessed measuring the E-A/E-V ratio by echocardiography. The left ventricle stroke work to pressure volume area ratio (SW/PVA) was also calculated. ResultsIn the overall cohort, 24 patients (39%) were VO2 responders, and 48 patients had high ventriculo-arterial (E-A/E-V) coupling ratio with a median value of 1.9 (1.6-2.4). Most of those patients were classified as VO2 responders (28 of 31 patients