Estimating the effective arterial elastance at bedside: a reply to a rebuttal

  • Denis ChemlaEmail author
  • Jean-Louis Teboul
  • Mathieu Jozwiak
Letter to the Editor

We are sorry to report that we do not find Monge Garcia et al. rebuttal [1] to our letter [2] convincing. Some of their points seem warranted, but so many of their claims demand challenge and are not evidence-based.

Claim 1 “Ignoring stroke volume, any peripheral estimation of Ea [the effective arterial elastance] will be valid as long as the arterial surrogate is close to Pes [the left ventricular end-systolic pressure LVESP]. In this regard, MAP [the mean arterial pressure], dicrotic notch pressure and 90% of aortic systolic pressure offer similar performance. But aortic, not femoral or radial pressure [ 1]”. As far as aortic pressure is concerned, this claim is not evidence-based. The opposite has been documented by two independent studies using high-fidelity pressure recordings and showing that MAP markedly underestimates LVESP while 90% aortic systolic arterial pressure (SAP) matches LVESP [ 3, 4] (Table  1). The important point is that in humans, particularly those with stiff or...


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Conflict of interest

None declared for all authors in the subject matter (pathophysiology).


  1. 1.
    Monge Garcia MI, Jian Z, Settels JJ, Hatib F, Cecconi M, Pinsky MR. Rebuttal to: As simple as possible, but not simpler: estimating the effective arterial elastance at bedside. J Clin Monit Comput. 2019. Scholar
  2. 2.
    Chemla D, Teboul JL, Jozwiak M. As simple as possible, but not simpler: estimating the effective arterial elastance at bedside. J Clin Monit Comput. 2019. Scholar
  3. 3.
    Kelly RP, Ting CT, Yang TM, Liu CP, Maughan WL, Chang MS, Kass DA. Effective arterial elastance as index of arterial vascular load in humans. Circulation. 1992;86:513–21.CrossRefGoogle Scholar
  4. 4.
    Chemla D, Antony I, Lecarpentier Y, Nitenberg A. Contribution of systemic vascular resistance and total arterial compliance to effective arterial elastance in humans. Am J Physiol Heart Circ Physiol. 2003;285:H614–20.CrossRefGoogle Scholar
  5. 5.
    Monge Garcia MI, Jian Z, Settels JJ, Hatib F, Cecconi M, Pinsky MR. Reliability of effective arterial elastance using peripheral arterial pressure as surrogate for left ventricular end-systolic pressure. J Clin Monit Comput. 2018. Scholar
  6. 6.
    Avolio AP, Van Bortel LM, Boutouyrie P, Cockcroft JR, McEniery CM, Protogerou AD, Roman MJ, Safar ME, Segers P, Smulyan H. Role of pulse pressure amplification in arterial hypertension: experts’ opinion and review of the data. Hypertension. 2009;54:375–83.CrossRefGoogle Scholar
  7. 7.
    Segers P, Mahieu D, Kips J, Rietzschel E, De Buyzere M, De Bacquer D, Bekaert S, De Backer G, Gillebert T, Verdonck P, Van Bortel L, Asklepios Investigators. Amplification of the pressure pulse in the upper limb in healthy, middle-aged men and women. Hypertension. 2009;54:414–20.CrossRefGoogle Scholar
  8. 8.
    Herbert A, Cruickshank JK, Laurent S, Boutouyrie P, Reference Values for Arterial Measurements Collaboration. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J. 2014;35:3122–33.CrossRefGoogle Scholar
  9. 9.
    Lacolley P, Regnault V, Segers P, Laurent S. Vascular smooth muscle cells and arterial stiffening: relevance in development, aging, and disease. Physiol Rev. 2017;97:1555–617.CrossRefGoogle Scholar
  10. 10.
    Jozwiak M, Millasseau S, Richard C, Monnet X, Mercado P, Dépret F, Alphonsine J-E, Teboul JL, Chemla D. Validation and critical evaluation of the effective arterial elastance in critically-ill patients. Crit Care Med. 2019;47:e314–24.CrossRefGoogle Scholar
  11. 11.
    Monge García MI, Santos A, Diez Del Corral B, Guijo González P, Gracia Romero M, Gil Cano A, Cecconi M. Noradrenaline modifies arterial reflection phenomena and left ventricular efficiency in septic shock patients: a prospective observational study. J Crit Care. 2018;47:280–6.CrossRefGoogle Scholar
  12. 12.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Denis Chemla
    • 1
    • 2
    Email author
  • Jean-Louis Teboul
    • 2
    • 3
  • Mathieu Jozwiak
    • 4
  1. 1.Service de Physiologie-Explorations FonctionnellesHôpitaux universitaires Paris Sud, Faculté de médecineLe Kremlin BicêtreFrance
  2. 2.INSERM UMR_S 999Hôpital Marie LannelongueLe Plessis RobinsonFrance
  3. 3.Service de Médecine Intensive-RéanimationHôpitaux universitaires Paris Sud, Faculté de médecineLe Kremlin BicêtreFrance
  4. 4.Service de Médecine Intensive-RéanimationHôpitaux universitaires Paris Centre - Hôpital CochinParisFrance

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