Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology

Abstract

O. Chioncel et al. Cardiogenic shock (CS) is a complex multifactorial clinical syndrome with extremely high mortality, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large spectrum of CS presentations resulting from the interaction between an acute cardiac insult and a patient's underlying cardiac and overall medical condition. Phenotyping patients with CS may have clinical impact on management because classification would support initiation of appropriate therapies. CS management should consider appropriate organization of the health care services, and therapies must be given to the appropriately selected patients, in a timely manner, whilst avoiding iatrogenic harm. Although several consensus-driven algorithms have been proposed, CS management remains challenging and substantial investments in research and development have not yielded proof of efficacy and safety for most of the therapies tested, and outcome in this condition remains poor. Future studies should consider the identification of the new pathophysiological targets, and high-quality translational research should facilitate incorporation of more targeted interventions in clinical research protocols, aimed to improve individual patient outcomes. Designing outcome clinical trials in CS remains particularly challenging in this critical and very costly scenario in cardiology, but information from these trials is imperiously needed to better inform the guidelines and clinical practice. The goal of this review is to summarize the current knowledge concerning the definition, epidemiology, underlying causes, pathophysiology and management of CS based on important lessons from clinical trials and registries, with a focus on improving in-hospital management.

Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome

“…[11] Cardiogenic shock was defined according to the last position statement from the Heart Failure Association of the ESC. [12] PE was diagnosed according to the last edition of the recommendations by the ESC [13] The primary objective of this study was to describe the prevalence of PE in this multi-center cohort and to identify the clinical, laboratory and echocardiographic parameters correlated to this condition during hospitalization. Secondary objective was to assess the association between PE and the risk of in-hospital mortality.…”

The inodilator levosimendan: 20 years of experience in various settings of cardiac care

“…It may arise as a de novo entity in a previously asymptomatic patient or as an acute exacerbation of previously diagnosed chronic HF. AHF may be regarded as an umbrella term describing a complex clinical syndrome that may include the following conditions: worsening or decompensated chronic HF; pulmonary edema; hypertensive AHF; cardiogenic shock; HF relating to acute coronary syndromes; and isolated right-sided HF [47]. Pharmacological interventions must acknowledge these distinct clinical and pathophysiological entities.…”

Circulating exosomal microRNAs as emerging non‐invasive clinical biomarkers in heart failure: Mega bio‐roles of a nano bio‐particle

“…HF represents a major leading cause of hospitalization and health care burden, and have a high prevalence and annually growing incidence with high morbidity and mortality worldwide. 1,2 The American Heart Association/ American Colleges of Cardiology (ACC/AHA) and European Society of Cardiology (ESC) have recommended several biomarkers and guidelines for the diagnosis/prognosis and treatments of HF patients. [3][4][5][6] Nevertheless, with the growing complexity and heterogeneity observed in HF progression, delineation of more reliable biomarkers with higher specificity and sensitivity for the early diagnosis and molecular monitoring of the disease state, and for having an accurate expectation of prognosis with sufficiently predictive precision is still urgent to optimize treatment options and decline mortality.…”

“…It is known as a syndrome in which the heart dysfunction leads to a mismatch between blood supply and demand of the organs. HF represents a major leading cause of hospitalization and health care burden, and have a high prevalence and annually growing incidence with high morbidity and mortality worldwide 1,2 . The American Heart Association/American Colleges of Cardiology (ACC/AHA) and European Society of Cardiology (ESC) have recommended several biomarkers and guidelines for the diagnosis/prognosis and treatments of HF patients 3–6 .…”