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Background <p>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.</p> Methods <p>A prospective observational cohort study conducted between July 2023 and November 2024 enrolled adults undergoing elective non-cardiac surgery. The ventriculo-arterial coupling index (<i>E</i><sub>a</sub>/<i>E</i><sub>es</sub>) 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 &lt; 65&#xa0;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).</p> Results <p>PIH occurred in 161/405 patients (39.8%). An <i>E</i><sub>a</sub>/<i>E</i><sub>es</sub> ratio &gt; 1 was associated with PIH (OR 2.95; 95% CI 1.08–8.03; <i>p</i> = 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<i> p</i> = 0.018) and provided 37% FNI (Holm-adjusted<i> p</i> = 0.199). The incorporation of VAC-related variables further increased the AUC to 0.785 (95% CI 0.739–0.831; Holm-adjusted<i> p</i> = 0.002) and yielded 46% FNI (Holm-adjusted<i> p</i> = 0.030). Compared with the clinical–echocardiographic model, incorporation of VAC-related variables provided an additional 14% FNI (Holm-adjusted<i> p</i> = 0.018) without a statistically significant AUC increase (0.017; 95% CI −0.004–0.039; Holm-adjusted<i> p</i> = 0.199).</p> Conclusion <p>PIH was common and was independently associated with impaired VAC, as reflected by an <i>E</i><sub>a</sub>/<i>E</i><sub>es</sub> ratio &gt; 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.</p>

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Predictive value of ventriculo-arterial coupling for hypotension after induction of anaesthesia: a prospective observational cohort study

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  • 发表日期：

    2026年4月21日

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  • Hong Chinh Le,
  • Chau Bich Ha Tran,
  • Thi Thu Trang Nguyen,
  • Ton Ngoc Vu Phan,
  • Duc Nam Nguyen,
  • Trung Hieu Duong,
  • Tran Huy Nhat Phung,
  • Huu Khanh Trinh Dong,
  • Yvon L. J. M. Deryck,
  • Minh Khoi Le

摘要

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.