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Hypotension on InductionVACNCT05969886

Ventricular-Arterial Coupling: A Predictor of Post-Induction Hypotension

An observational study of Hypotension on Induction, run by University Medical Center Ho Chi Minh City (UMC) at 1 site in Vietnam.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Post-induction hypotension (PIH) is a common occurrence during the period from induction of general anesthesia to initiation of incision. PIH has been identified as an independent risk factor for postoperative major complications. Identifying high-risk patients for PIH could potentially help prevent its occurrence. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Hypotension on Induction
How many people
475 participants
Where
1 siteVietnam
Study dates
3 Jul 2023to 10 Dec 2024
Phase
Observational
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients with American Society of Anesthesiologists (ASA) physical status 1 - 4 who underwent elective surgery

Who may be able to join

  • Patients ≥ 18 years old.
  • Patients with ASA (American Society of Anesthesiologists) physical status 1 - 4.
  • Elective non-cardiac, non-obstetric, and non-gynaecologic surgery
  • Preoperative transthoracic echocardiography was performed within 48 hours before surgery. The values of Ees and Ea were determined by the method of Chen.
  • Patients consented to participate in the study.
  • Patients scheduled for surgery undergoing standard general anesthesia (protocol: see below) with endotracheal intubation.
  • Patients were hemodynamically stable until the preoperative period.

Who cannot join

  • Uncorrected congenital heart disease, moderate-to-severe valvular disease or pulmonary hypertension, arrhythmias, anticipated difficult airway, and known allergy to anaesthetic agents.

Trial locations and contacts

1 site in 1 country.

Vietnam1 site
  • University Medical Centre Ho Chi Minh

    Ho Chi Minh City

Other trials in Vietnam

About this study

Official title: Predictive Value of Ventricular-Arterial Coupling for Post-Induction Hypotension: A Prospective Observational Cohort Study

Post-induction hypotension (PIH) is a common occurrence during the period from induction of general anesthesia to initiation of incision. PIH has been identified as an independent risk factor for postoperative major complications. Identifying high-risk patients for PIH could potentially help prevent its occurrence. Several risk factors associated with PIH have been identified, including patient conditions and use of specific anesthetic agents. Ventricular-arterial coupling (VAC) is evaluated using the ratio Ea/Ees and represents the interaction between the left ventricle (LV) and the arterial system. It reflects how changes in LV contractility (Ees) and changes in arterial load (Ea) work together to maintain optimal LV performance. A study aims to investigate the relationship between preoperative Ea/Ees ratio and the incidence of PIH (defined as MAP < 65 mmHg).

Read the detailed description

Post-induction hypotension (PIH) is a common event due to general anesthesia in patients undergoing surgery. It is described as hypotension occurring during the period from induction of general anesthesia to initiation of incision. A universal definition of intraoperative hypotension is lacking, leading to inconsistent rates of occurrence for PIH. According to Yoshimura et al., PIH occurs in 34% of patients using the mean arterial pressure (MAP) definition of < 55 mmHg, whereas Maheshwari found PIH in 53% of patients using a MAP definition of < 65 mmHg. Furthermore, Maheshwari et al. demonstrated that PIH was an independent risk factor for postoperative major complications such as myocardial injury, cerebrovascular events, and acute kidney injury.

If high-risk patients for PIH could be identified we might potentially prevent PIH. In a systematic review, Chen et al. pointed out that the risk factors associated with PIH were ASA (American Society of Anesthesiologists) III-V, advanced age, emergency cases, hypovolaemia, long-term use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, use of propofol and high-dose of opioid. This study suggests that PIH may be the result of an interaction between the anesthetic agent and the cardiovascular condition of the patient. Conditions such as moderate-to-severe aortic regurgitation, moderate-to-severe mitral regurgitation, regional wall motion abnormalities, and echocardiography findings (e.g. elevated ratio of peak early diastolic transmitral flow velocity to annular velocity) have been identified as PIH-independent risk factors.

End-systolic elastance (Ees) is a measure of the contractile state of the left ventricle (LV). It represents the relationship between LV end-systolic pressure (LVESP) and end-systolic volume (ESV). Effective arterial elastance (Ea) is a measure of the total arterial load on the LV and is calculated as the ratio of LVESP to stroke volume (SV). Ventricular-arterial coupling (VAC), assessed by the ratio Ea/Ees, describes the interaction between the LV and arterial system. VAC reflects the interplay between the changes in LV contractility (Ees) and changes in arterial load (Ea) to maintain optimal LV performance.

Aktas et al. analyzed Ea as a predictor of PIH. The results of this study showed that pre-induction Ea had excellent predictability of hypotension. However, Ees values were not determined, thus making it speculative to conclude that pre-induction VAC is impaired in patients with high Ea. There are no studies available that assessed the role of preoperative VAC in predicting PIH. Therefore, we will investigate the relationship between the preoperative Ea/Ees ratio and the incidence of PIH (: hypotension being defined as MAP < 65 mmHg).

Keywords
Ventricular-Arterial Coupling (VAC), Ea/Ees ratio, Post-induction hypotension (PIH), Risk factors for PIH

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of Post-Induction Hypotension

    Post-induction hypotension (PIH) was defined according to the protocol criteria and assessed during the interval from induction of anesthesia to surgical incision. The incidence of PIH was calculated as the number of analyzed participants who developed PIH during this interval.

    Measured: From induction of anesthesia to surgical incision, up to 1 hour

Secondary outcomes (2)
  1. Area Under the Receiver Operating Characteristic Curve for Prediction of Post-Induction Hypotension

    Predictive performance for post-induction hypotension (PIH) was evaluated using logistic regression models. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Clinical variables, echocardiographic measurements, and ventriculo-arterial coupling (VAC)-related variables were evaluated for prediction of PIH. Higher AUC values indicate better model discrimination.

    Measured: From induction of anesthesia to surgical incision, up to 1 hour

  2. Fractional New Information Added for Prediction of Post-Induction Hypotension

    Incremental predictive value for post-induction hypotension (PIH) was assessed using fractional new information (FNI). FNI was used to quantify the additional predictive information provided by echocardiographic measurements and ventriculo-arterial coupling (VAC)-related variables when added to the clinical prediction model.

    Measured: From induction of anesthesia to surgical incision, up to 1 hour

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Aug 2023
  2. Study start3 Jul 2023
  3. Primary completion20 Nov 2024
  4. Study completion10 Dec 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
475 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05969886
Sponsor's protocol ID
32/GCN-HDDD
Other IDs
No: 32/GCN-HDDD
Acronym
VAC
Status last verified
Dec 2024
First submitted
24 Jul 2023
Last updated
15 Sep 2026
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Yes, there is a plan to make individual participant data (IPD) available. The de-identified dataset underlying the findings of this study will be shared upon reasonable request. Researchers can request access by contacting chinh.lh@umc.edu.vn. Requests will be reviewed to ensure compliance with ethical and legal standards.

Publications

  • Yoshimura M, Shiramoto H, Koga M, Morimoto Y. Preoperative echocardiography predictive analytics for postinduction hypotension prediction. PLoS One. 2022 Nov 28;17(11):e0278140. doi: 10.1371/journal.pone.0278140. eCollection 2022.

    PubMed 36441797
  • Maheshwari K, Turan A, Mao G, Yang D, Niazi AK, Agarwal D, Sessler DI, Kurz A. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia. 2018 Oct;73(10):1223-1228. doi: 10.1111/anae.14416. Epub 2018 Aug 24.

    PubMed 30144029
  • Sudfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, Saugel B. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017 Jul 1;119(1):57-64. doi: 10.1093/bja/aex127.

    PubMed 28974066
  • Chen B, Pang QY, An R, Liu HL. A systematic review of risk factors for postinduction hypotension in surgical patients undergoing general anesthesia. Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7044-7050. doi: 10.26355/eurrev_202111_27255.

    PubMed 34859868
  • Tarao K, Daimon M, Son K, Nakanishi K, Nakao T, Suwazono Y, Isono S. Risk factors including preoperative echocardiographic parameters for post-induction hypotension in general anesthesia. J Cardiol. 2021 Sep;78(3):230-236. doi: 10.1016/j.jjcc.2021.03.010. Epub 2021 Apr 8.

    PubMed 33838982
  • Monge Garcia MI, Santos A. Understanding ventriculo-arterial coupling. Ann Transl Med. 2020 Jun;8(12):795. doi: 10.21037/atm.2020.04.10.

    PubMed 32647720
  • Guinot PG, Andrei S, Longrois D. Ventriculo-arterial coupling: from physiological concept to clinical application in peri-operative care and ICUs. Eur J Anaesthesiol Intensive Care. 2022 Aug 3;1(2):e004. doi: 10.1097/EA9.0000000000000004. eCollection 2022 Apr.

    PubMed 39916686
  • Aktas Yildirim S, Sarikaya ZT, Dogan L, Ulugol H, Gucyetmez B, Toraman F. Arterial Elastance: A Predictor of Hypotension Due to Anesthesia Induction. J Clin Med. 2023 Apr 27;12(9):3155. doi: 10.3390/jcm12093155.

    PubMed 37176595
  • Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA, Kawaguchi M, Kass DA. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol. 2001 Dec;38(7):2028-34. doi: 10.1016/s0735-1097(01)01651-5.

    PubMed 11738311
  • Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019 Jan;32(1):1-64. doi: 10.1016/j.echo.2018.06.004. Epub 2018 Oct 1. No abstract available.

    PubMed 30282592
  • Cho JY, Kim KH. Evaluation of Arterial Stiffness by Echocardiography: Methodological Aspects. Chonnam Med J. 2016 May;52(2):101-6. doi: 10.4068/cmj.2016.52.2.101. Epub 2016 May 20.

    PubMed 27231673
  • Liu N, Chazot T, Genty A, Landais A, Restoux A, McGee K, Laloe PA, Trillat B, Barvais L, Fischler M. Titration of propofol for anesthetic induction and maintenance guided by the bispectral index: closed-loop versus manual control: a prospective, randomized, multicenter study. Anesthesiology. 2006 Apr;104(4):686-95. doi: 10.1097/00000542-200604000-00012.

    PubMed 16571963
  • Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med. 2008 Mar 13;358(11):1097-108. doi: 10.1056/NEJMoa0707361.

    PubMed 18337600

Questions about this trial

What is this clinical trial studying?

An observational study of Hypotension on Induction, run by University Medical Center Ho Chi Minh City (UMC) at 1 site in Vietnam.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Vietnam. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 15 Sep 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of Post-Induction Hypotension (time frame: From induction of anesthesia to surgical incision, up to 1 hour). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05969886, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Sep 2026.

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