Cardiovascular Subphenotypes in ARDS: Diagnostic and Therapeutic Implications and Overlap with Other ARDS Subphenotypes

Abstract

Acute respiratory distress syndrome (ARDS) is a highly heterogeneous clinical condition. Shock is a poor prognostic sign in ARDS, and heterogeneity in its pathophysiology may be a barrier to its effective treatment. Although right ventricular dysfunction is commonly implicated, there is no consensus definition for its diagnosis, and left ventricular function is neglected. There is a need to identify the homogenous subgroups within ARDS, that have a similar pathobiology, which can then be treated with targeted therapies. Haemodynamic clustering analyses in patients with ARDS have identified two subphenotypes of increasingly severe right ventricular injury, and a further subphenotype of hyperdynamic left ventricular function. In this review, we discuss how phenotyping the cardiovascular system in ARDS may align with haemodynamic pathophysiology, can aid in optimally defining right ventricular dysfunction and can identify tailored therapeutic targets for shock in ARDS. Additionally, clustering analyses of inflammatory, clinical and radiographic data describe other subphenotypes in ARDS. We detail the potential overlap between these and the cardiovascular phenotypes.

Subphenotypes of Acute Respiratory Distress Syndrome: Advancing Towards Precision Medicine

“…Most recently, Chotalia et al [ 61 ] have utilized LCA to identify novel cardiovascular subphenotypes in ARDS. They combined transthoracic echo and clinical variables from more than 1,000 patients who were diagnosed with ARDS.…”

“…This hyperdynamic subphenotype has a 59% mortality and does independently predict an increased risk of death. Chotalia et al [ 61 ] established a parsimonious model to divide patients into these distinct subphenotypes using parameters available by bedside transthoracic echocardiogram and found that measures of RV systolic dysfunction and cardiac index can accurately discriminate the subphenotypes.…”