Intensive care medicine experimental · 2026
Predictive value of ventriculo-arterial coupling for hypotension after induction of anaesthesia: a prospective observational cohort study.
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Le Hong Chinh, Tran Chau Bich Ha, Nguyen Thi Thu Trang, Phan Ton Ngoc Vu, Nguyen Duc Nam, Duong Trung Hieu, Phung Tran Huy Nhat, Dong Huu Khanh Trinh, Deryck Yvon L J M, Le Minh Khoi
Аннотация
BACKGROUND: Post-induction hypotension (PIH) is associated with acute perioperative organ injury. We quantified the added value of echocardiographic parameters and ventriculo-arterial coupling (VAC)-related variables for the prediction of PIH.
METHODS: A prospective observational cohort study conducted between July 2023 and November 2024 enrolled adults undergoing elective non-cardiac surgery. The ventriculo-arterial coupling index (Ea/Ees) was derived pre-operatively using transthoracic echocardiography combined with non-invasive blood pressure measurements. PIH was defined as the first occurrence of mean arterial pressure < 65 mmHg between anaesthesia induction and surgical incision. Predictors were analysed using a generalised additive model to account for potential non-linear associations. Incremental prognostic value was assessed using the fraction of new information (FNI), a reclassification-based metric, and changes in the area under the receiver operating characteristic curve (AUC).
RESULTS: PIH occurred in 161/405 patients (39.8%). An Ea/Ees ratio > 1 was associated with PIH (OR 2.95; 95% CI 1.08-8.03; p = 0.034). The clinical model showed an AUC of 0.720 (95% CI 0.669-0.771). The addition of echocardiographic parameters increased the AUC to 0.768 (95% CI 0.720-0.816; Holm-adjusted p = 0.018) and provided 37% FNI (Holm-adjusted p = 0.199). The incorporation of VAC-related variables further increased the AUC to 0.785 (95% CI 0.739-0.831; Holm-adjusted p = 0.002) and yielded 46% FNI (Holm-adjusted p = 0.030). Compared with the clinical-echocardiographic model, incorporation of VAC-related variables provided an additional 14% FNI (Holm-adjusted p = 0.018) without a statistically significant AUC increase (0.017; 95% CI -0.004-0.039; Holm-adjusted p = 0.199).
CONCLUSION: PIH was common and was independently associated with impaired VAC, as reflected by an Ea/Ees ratio > 1. Incorporation of echocardiographic parameters improved the discriminatory performance of a clinical prediction model, and the further addition of VAC-related variables provided meaningful improvement in risk reclassification, despite only modest gains in overall discrimination.
METHODS: A prospective observational cohort study conducted between July 2023 and November 2024 enrolled adults undergoing elective non-cardiac surgery. The ventriculo-arterial coupling index (Ea/Ees) was derived pre-operatively using transthoracic echocardiography combined with non-invasive blood pressure measurements. PIH was defined as the first occurrence of mean arterial pressure < 65 mmHg between anaesthesia induction and surgical incision. Predictors were analysed using a generalised additive model to account for potential non-linear associations. Incremental prognostic value was assessed using the fraction of new information (FNI), a reclassification-based metric, and changes in the area under the receiver operating characteristic curve (AUC).
RESULTS: PIH occurred in 161/405 patients (39.8%). An Ea/Ees ratio > 1 was associated with PIH (OR 2.95; 95% CI 1.08-8.03; p = 0.034). The clinical model showed an AUC of 0.720 (95% CI 0.669-0.771). The addition of echocardiographic parameters increased the AUC to 0.768 (95% CI 0.720-0.816; Holm-adjusted p = 0.018) and provided 37% FNI (Holm-adjusted p = 0.199). The incorporation of VAC-related variables further increased the AUC to 0.785 (95% CI 0.739-0.831; Holm-adjusted p = 0.002) and yielded 46% FNI (Holm-adjusted p = 0.030). Compared with the clinical-echocardiographic model, incorporation of VAC-related variables provided an additional 14% FNI (Holm-adjusted p = 0.018) without a statistically significant AUC increase (0.017; 95% CI -0.004-0.039; Holm-adjusted p = 0.199).
CONCLUSION: PIH was common and was independently associated with impaired VAC, as reflected by an Ea/Ees ratio > 1. Incorporation of echocardiographic parameters improved the discriminatory performance of a clinical prediction model, and the further addition of VAC-related variables provided meaningful improvement in risk reclassification, despite only modest gains in overall discrimination.