Ventriculo-arterial coupling: from physiological concept to clinical application in peri-operative care and ICUs

As an extension of the traditional heart-centred pressure-flow model, the ventriculo-arterial coupling concept is based on the pressure-volume relationship of the left ventricle and the vascular system. Even though ventriculo-arterial coupling has been studied in cardiology for more than 30 years, its value in clinical practice in anaesthesia and ICU remains poorly known and used. The clinical interest in ventriculo-arterial coupling is derived from its strong connection with cardiac energetics and efficiency. An alteration of ventriculo-arterial coupling is a marker of disease severity and is associated with outcome. The main categories of cardio-circulatory failures observed in ICU patients commonly exhibit alterations in ventriculo-arterial coupling with typical patterns. Furthermore, the effectiveness of usual haemodynamic treatments and interventions correlates with ventriculo-arterial coupling improvements in ICU patients. Consequently, treatment and management bundles may be proposed to specifically target the correction of ventriculo-arterial uncoupling to optimise the patients' haemodynamic status and outcome. Restoring ventriculo-arterial coupling with treatments improves outcomes in subgroups of ICU patients. Even though ventriculo-arterial coupling evaluation cannot be considered as a part of the basic core curriculum of anaesthesiologists and ICU residents, anaesthesia and ICU practitioners must be familiarised with the clinical significance of ventriculo-arterial (un)coupling and availability of its bedside noninvasive evaluation. The understanding of ventriculo-arterial coupling may be particularly important in complex haemodynamic clinical situations.