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Updated: Apr 23, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Predictive value of ventriculo-arterial coupling for hypotension after induction of anaesthesia: a prospective
Hong Chinh Le1,2, Chau Bich Ha Tran3, Thi Thu Trang Nguyen3
1Department of Critical Care Medicine, Emergency and Clinical Toxicology, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang street, Cho Lon Ward, Ho Chi Minh City, 72714, Vietnam.
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.
