Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Dec 7;11(1):87.
doi: 10.1186/s40635-023-00573-9.

Pathophysiological implications of ventriculoarterial coupling in septic shock

Michael R Pinsky  1 , Fabio Guarracino  2
Affiliations
Review

Pathophysiological implications of ventriculoarterial coupling in septic shock

Michael R Pinsky et al. Intensive Care Med Exp. .
No abstract available

Keywords: Arterial elastance; Coupling; Resuscitation; Sepsis; Septic shock; Ventricular elastance.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Pressure/volume loop describing ventriculo-arterial coupling. Plv left ventricular pressure, Vlv left ventricular volume, ESP left ventricle end-systolic pressure, ESV left ventricle end-systolic volume, EDV left ventricle end-diastolic volume, Ea arterial elastance, Ees end-systolic elastance, VAC ventriculo-arterial coupling, LVeff left ventricular efficiency, PVA pressure/volume area, SW stroke work, PE potential energy, SV stroke volume. Modified from Guarracino et al. (2019) Cardiovascular determinants of resuscitation from sepsis and septic shock. Crit Care 23:118 (http://creativecommons.org/licenses/by/4.0/)
Fig. 2
Fig. 2
Effect of alterations in either Ees (A) or Ea (B) on stroke volume. P left ventricular pressure, V left ventricular volume, ESP left ventricle end-systolic pressure, EDP left ventricle end-diastolic pressure, ESV left ventricle end-systolic volume, EDV left ventricle end-diastolic volume, Ea arterial elastance, Ees end-systolic elastance
Fig. 3
Fig. 3
Effect of vasopressor on systolic pressure and stroke volume in the presence of reduced Ees. P left ventricular pressure, V left ventricular volume, ESP left ventricle end-systolic pressure, EDP left ventricle end-diastolic pressure, ESV left ventricle end-systolic volume, EDV left ventricle end-diastolic volume, Ea arterial elastance, Ees end-systolic elastance, VAC ventriculo-arterial coupling, LVeff left ventricular efficiency, CO cardiac output, CI cardiac index, NE norepinephrine. Modified from Guarracino et al. (2019) Cardiovascular determinants of resuscitation from sepsis and septic shock. Critical Care 23:118 (http://creativecommons.org/licenses/by/4.0/)
Fig. 4
Fig. 4
Ventriculo-arterial coupling guided hemodynamic treatment. Ees ventricularelastance, EA arterialelastance, VAC ventriculo-arterialcoupling. (Modified from: Guarracino et al. Management of cardiovascular insufficiency in ICU: the BEAT approach. Minerva Anestesiol 2021 87(4):476–480. With permission.)
Fig. 5
Fig. 5
iElastance App. Operator inserted blood pressure, stroke volume, ejection fraction, and ejection times allows for the immediate display of Ea, Ees and VAC. On the right panel the echo images show how to measure the left ventricle ejection fraction (EF) and to detect the systolic ejection times. Abbreviations as defined in the text
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Guarracino F, Baldassarri R, Pinsky MR. Ventriculo-arterial decoupling in acutely altered hemodynamic states. Crit Care. 2013;17(2):213. doi: 10.1186/cc12522. - DOI - PMC - PubMed
    1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Daoi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. doi: 10.1007/s00134-021-06506-y. - DOI - PMC - PubMed
    1. Guarracino F, Bertini P, Pinsky MR. Cardiovascular determinants of resuscitation from sepsis and septic shock. Crit Care. 2019;23:118. doi: 10.1186/s13054-019-2414-9. - DOI - PMC - PubMed
    1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–851. doi: 10.1056/NEJMra1208623. - DOI - PubMed
    1. Kass DA, Kelly RP. Ventriculo-arterial coupling: concepts, assumptions, and applications. Ann Biomed Eng. 1992;20:41–62. doi: 10.1007/BF02368505. - DOI - PubMed

LinkOut - more resources