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Journal of Clinical Monitoring and Computing

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23-03-2021 | Heart Surgery | Original Research

Velocity-pressure loops can estimate intrinsic and pharmacologically induced changes in cardiac afterload during non-cardiac surgery. An observational study

Authors: Arthur Le Gall, Étienne Gayat, Jona Joachim, Samuel Cohen, Alex Hong, Joaquim Matéo, Cédric Buxin, Sandrine Millasseau, Alexandre Mebazaa, Fabrice Vallée

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2022

Abstract

Purpose

Continuous measurement of aortic pressure and aortic flow velocity signals in the operating theatre allows us to draw velocity-pressure (Vel-Pre) loops. The global afterload angle (GALA), derived from the Vel-Pre loops, has been linked to cardiac afterload indicators. As age is the major determinant of constitutive arterial stiffness, we aimed to describe (1) the evolution of the GALA according to age in a large cohort of anesthetized patients and (2) GALA variations induced by haemodynamic interventions.

Methods

We included patients for whom continuous monitoring of arterial pressure and cardiac output were indicated. Fluid challenges or vasopressors were administered to treat intra-operative hypotension. The primary endpoint was the comparison of the GALA values between young and old patients. The secondary endpoint was the difference in the GALA values before and after haemodynamic interventions.

Results

We included 133 anaesthetized patients: 66 old and 67 young patients. At baseline, the GALA was higher in the old patients than in young patients (38 ± 6 vs. 25 ± 4 degrees; p < 0.001). The GALA was positively associated with age (p < 0.001), but the mean arterial pressure (MAP) and cardiac output were not. The GALA did not change after volume expansion, regardless of the fluid response, but it did increase after vasopressor administration. Furthermore, while a vasopressor bolus led to a similar increase in MAP, phenylephrine induced a more substantial increase in the GALA than noradrenaline (+ 12 ± 5° vs. + 8 ± 5°; p = 0.01).

Conclusion

In non-cardiac surgery, the GALA seems to be associated with both intrinsic rigidity (reflected by age) and pharmacologically induced vasoconstriction changes (by vasopressors). In addition, the GALA can discriminate the differential effects of phenylephrine and noradrenaline. These results should be confirmed in a prospective, ideally randomized, trial.

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Title: Velocity-pressure loops can estimate intrinsic and pharmacologically induced changes in cardiac afterload during non-cardiac surgery. An observational study
Authors: Arthur Le Gall
Étienne Gayat
Jona Joachim
Samuel Cohen
Alex Hong
Joaquim Matéo
Cédric Buxin
Sandrine Millasseau
Alexandre Mebazaa
Fabrice Vallée
Publication date: 23-03-2021
Publisher: Springer Netherlands
Keywords: Heart Surgery
Heart Surgery
Published in: Journal of Clinical Monitoring and Computing / Issue 2/2022
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-021-00686-0

At a glance: The STEP trials

Springer Medicine

Velocity-pressure loops can estimate intrinsic and pharmacologically induced changes in cardiac afterload during non-cardiac surgery. An observational study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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