Ventriculoarterial decoupling in human septic shock

Introduction Septic 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. Methods In 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 (Ees SB ) method. Ea was calculated as 0.9 systolic arterial pressure/stroke volume, and then the Ea/Ees SB ratio was calculated (normal value <1.36). Results In group S, 21 patients had an Ea/Ees SB ratio >1.36 (uncoupled). The four patients with Ea/Ees SB ratios ≤1.36 had higher Ees SB values than patients with Ea/Ees SB 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/Ees SB ratios. No correlation was found between Ees SB and left ventricular ejection fraction and between Ea/Ees SB ratio and mixed venous oxygen saturation in septic shock patients. Conclusions Upon 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.