Purpose of review Here, we review the importance of using hemodynamic data to guide therapy and risk stratification in cardiogenic shock as well as the various definitions of this syndrome that have been used in prior studies. Furthermore, we provide perspective regarding the controversy surrounding pulmonary artery (PA) catheter use as well as current society guidelines and scientific statements. Lastly, we review the technical aspects for accurate interpretation of data of cardiogenic shock. Recent findings More recent studies specifically evaluating cardiogenic shock patients have shown higher mortality when PA catheters were not used. Furthermore, initiatives are underway to develop more standardized definitions of cardiogenic shock, including the SCAI Shock Classification Scheme. Only by having a standardized fashion of conveying severity of shock will we be able to more systematically study this patient population and improve outcomes moving forward. Summary PA catheters are critical to the prognostication and management of a subset of patients with cardiopulmonary disease, particularly in those with pulmonary hypertension, cardiogenic shock, or requiring mechanical circulatory support or undergoing evaluation for advanced heart failure therapies.

Right ventricular (RV) failure remains a major complication after surgical implantation of a left ventricular assist device (LVAD). While the use of a percutaneous RV assist device has been described as a short-term bridge to recovery in end-stage heart failure patients with early post-operative RV failure after index LVAD implant, management of refractory late RV failure remains challenging in these patients. We report the first successful case of extended Impella RP use as a safe and effective bridge to orthotopic heart transplant in an LVAD patient with refractory, haemodynamically significant late RV failure. The Impella RP provided support for 37 days. Haemodynamically intolerant arrhythmia precluded use of inotropic support. No adverse complications related to percutaneous Impella RP support were seen. We also review potential considerations for mechanical circulatory support strategies in this setting: central RV assist device cannulation requires sternotomy incision that can impact subsequent cardiac surgeries, while percutaneous Protek Duo insertion requires adequate vessel size and patency. With an LVAD in situ, veno-arterial extracorporeal membrane oxygenation was not considered for isolated RV support in this case. The patient is currently over 6 months post-orthotopic heart transplant.

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INTRODUCTION: Epidemiological studies show an association between preeclampsia and the development of cardiovascular disease. Does an association exist regarding metabolic disease? METHODS: Women with a discharge diagnosis of preeclampsia from 2009-2015 were identified from our integrated health care system database. We retrospectively collected demographic and cardiovascular risk factor data by chart review on women with preeclampsia and age/race matched controls from the year 2012. We then assessed 7-year follow-up in these cases and controls. A bivariate matched analysis and logistic regression were used to identify associated factors for preeclampsia while adjusting for other variables. RESULTS: The incidence of preeclampsia within our network in 2012 was 10.4%. At 7-year follow-up, we found that the cases group have an increased incidence of new-onset hypertension (30.7% vs 2.6%, p<.0001), hyperlipidemia (13.1% vs 2.3%, P<.0001) and diabetes (8.5% vs 1.9%, P<.0001) compared to controls. Hypertension, hyperlipidemia and diabetes served as markers of metabolic disease. Follow-up with a PCP occurred in 19.5% of preeclamptic patients and 14.9% of controls. Statistical analysis showed that preeclampsia was an independent risk factor for current hypertension (OR 6.7 [95% CI 3.4-10.8]), hyperlipidemia (OR 6.5 [95% CI 3.5-10.3]) and diabetes (OR 3.8 [95% CI 1.8-8.3]). CONCLUSION: Our findings support a relationship between preeclampsia and the development of metabolic disease. The diagnosis of preeclampsia serves as an independent predictor for the development of both cardiovascular and metabolic disease. This data highlights the necessity for establishing follow-up guidelines for preeclamptic patients when planning preventative medical interventions as it relates to cardiovascular and metabolic disease.