Dynamics of ventriculo-arterial coupling and peripheral tissue perfusion during early resuscitation of septic shock.
7 affiliations
- 1Department of Intensive Care Medicine, Fundación Valle del Lili, Cali, Colombia.
- 2Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia.
- 3Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
- 4Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. USA.
- 5Critical Care Division, Integrated Hospital Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
- 6Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
- 7Faculty of Medicine, University of Banja Luka. Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
Abstract
Background
Left ventriculo-arterial coupling (LVAC), the ratio of arterial elastance to left ventricular end-systolic elastance, is a dimensionless index that depicts the interaction between arterial load and cardiac contractility, reflecting energy transmission from the heart to the proximal arterial tree. Nevertheless, how dynamic variations of LVAC may impact tissue perfusion remains unclear. We evaluated the dynamic relationship between LVAC and capillary refill time (CRT), a peripheral perfusion surrogate, during early resuscitation of septic shock.Methods
Adult patients were prospectively included within 4-h of meeting Sepsis-3.0 septic shock criteria. LVAC was estimated at inclusion and 6-hours later by combining transthoracic echocardiography with arterial pressure monitoring, while CRT was simultaneously assessed. Patients were classified as uncoupled when LVAC > 1.36. Variations in CRT between baseline and 6-h were compared across four groups defined by LVAC evolution: (1) coupled-to-coupled; (2) coupled-to-uncoupled; (3) uncoupled-to-coupled; (4) uncoupled-to-uncoupled. Additionally, paired measurements before/after fluid loading and/or dobutamine initiation were analyzed. CRT differences among groups were compared using Kruskal-Wallis testing, followed by Dunn's post-hoc test for pairwise comparisons. Paired-Wilcoxon tests assessed CRT variations before/after interventions according to pre-intervention LVAC status.Results
Eighty-four patients were included. CRT variation between baseline and 6-h differed significantly among groups (Kruskal-Wallis, p = 0.013), with CRT improvement in uncoupled-to-coupled (-33.8 [-53.1 to -1.2]%, p = 0.013) and worsening in coupled-to-uncoupled patients (17.5 [7.1-31.3]%, p = 0.013). Persistently coupled and uncoupled groups exhibited heterogeneous CRT responses at 6-h. Thirty-one fluid loads and thirty-two inotrope interventions were also analyzed. CRT decreased after dobutamine in initially uncoupled patients (-26.2%, p = 0.007) but not after fluid loading (-9.5%, p = 0.656) despite both interventions significantly increasing stroke volume in uncoupled LVAC condition (+14.0%, p = 0.021 and +14.2%, p < 0.001, for fluids and dobutamine, respectively). CRT did not change after either intervention in patients already coupled.Conclusion
Although LVAC improvement was associated with recovery of peripheral perfusion in some patients, and its deterioration with CRT prolongation in others, this relationship proved to be weak. Indeed, inconsistent CRT behavior among persistently coupled or uncoupled patients, and the heterogeneous response to resuscitative interventions suggest peripheral perfusion often evolves independently of energy transmitted from the heart to proximal arterial tree.
Related
- Clinical relevance of ventriculo-arterial coupling and how to assess it at the bedside
- Heterogeneous cardiovascular responses to acute mean arterial pressure augmentation in septic shock: the role of ventriculo-arterial coupling and venous return
- Right Ventricular Dysfunction and Ventriculo‐Arterial Uncoupling in Heart Failure With Preserved Ejection Fraction: A Phenotype‐Specific Review of Mechanisms, Diagnosis, and Therapeutic Strategies
- Ventriculo-arterial coupling in acute heart failure: prognostic and therapeutic insights - a systematic review and meta-analysis of multivariable-adjusted data
- Sarcopenia and outcomes after revascularization for peripheral arterial disease: a scoping review
BibTeX
@article{ruiz2026dynamics,
title = {{Dynamics of ventriculo-arterial coupling and peripheral tissue perfusion during early resuscitation of septic shock.}},
author = {Juan Daniel Caicedo Ruiz and Gustavo García Gallardo and Jose Luis Aldana and Eduardo Kattan and Ricardo Castro and Glenn Hernandez and Michael Pinsky and Jihad Mallat and Gustavo Adolfo Ospina-Tascón},
journal = {Annals of intensive care},
year = {2026},
month = oct,
doi = {10.1016/j.aicoj.2026.100179},
url = {https://europepmc.org/article/MED/42898064},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Dynamics of ventriculo-arterial coupling and peripheral tissue perfusion during early resuscitation of septic shock.
AU - Juan Daniel Caicedo Ruiz
AU - Gustavo García Gallardo
AU - Jose Luis Aldana
AU - Eduardo Kattan
AU - Ricardo Castro
AU - Glenn Hernandez
AU - Michael Pinsky
AU - Jihad Mallat
AU - Gustavo Adolfo Ospina-Tascón
PY - 2026
DA - 2026/10/03
JO - Annals of intensive care
DO - 10.1016/j.aicoj.2026.100179
UR - https://europepmc.org/article/MED/42898064
AB - Background Left ventriculo-arterial coupling (LVAC), the ratio of arterial elastance to left ventricular end-systolic elastance, is a dimensionless index that depicts the interaction between arterial load and cardiac contractility, reflecting energy transmission from the heart to the proximal arterial tree. Nevertheless, how dynamic variations of LVAC may impact tissue perfusion remains unclear. We evaluated the dynamic relationship between LVAC and capillary refill time (CRT), a peripheral perfusion surrogate, during early resuscitation of septic shock.Methods Adult patients were prospectively included within 4-h of meeting Sepsis-3.0 septic shock criteria. LVAC was estimated at inclusion and 6-hours later by combining transthoracic echocardiography with arterial pressure monitoring, while CRT was simultaneously assessed. Patients were classified as uncoupled when LVAC > 1.36. Variations in CRT between baseline and 6-h were compared across four groups defined by LVAC evolution: (1) coupled-to-coupled; (2) coupled-to-uncoupled; (3) uncoupled-to-coupled; (4) uncoupled-to-uncoupled. Additionally, paired measurements before/after fluid loading and/or dobutamine initiation were analyzed. CRT differences among groups were compared using Kruskal-Wallis testing, followed by Dunn's post-hoc test for pairwise comparisons. Paired-Wilcoxon tests assessed CRT variations before/after interventions according to pre-intervention LVAC status.Results Eighty-four patients were included. CRT variation between baseline and 6-h differed significantly among groups (Kruskal-Wallis, p = 0.013), with CRT improvement in uncoupled-to-coupled (-33.8 [-53.1 to -1.2]%, p = 0.013) and worsening in coupled-to-uncoupled patients (17.5 [7.1-31.3]%, p = 0.013). Persistently coupled and uncoupled groups exhibited heterogeneous CRT responses at 6-h. Thirty-one fluid loads and thirty-two inotrope interventions were also analyzed. CRT decreased after dobutamine in initially uncoupled patients (-26.2%, p = 0.007) but not after fluid loading (-9.5%, p = 0.656) despite both interventions significantly increasing stroke volume in uncoupled LVAC condition (+14.0%, p = 0.021 and +14.2%, p < 0.001, for fluids and dobutamine, respectively). CRT did not change after either intervention in patients already coupled.Conclusion Although LVAC improvement was associated with recovery of peripheral perfusion in some patients, and its deterioration with CRT prolongation in others, this relationship proved to be weak. Indeed, inconsistent CRT behavior among persistently coupled or uncoupled patients, and the heterogeneous response to resuscitative interventions suggest peripheral perfusion often evolves independently of energy transmitted from the heart to proximal arterial tree.
SN - 2110-5820
ER -