Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

Abraham, Jacob; Blumer, Vanessa; Burkhoff, Daniel; Pahuja, Mohit; Sinha, Shashank S.; Rosner, Carolyn; Vorovich, Esther; Grafton, Gillian; Bagnola, Aaron; Hernández-Montfort, Jaime; Kapur, Navin K.

doi:10.1016/j.cardfail.2021.08.010

Cited by 71 publications

(44 citation statements)

References 110 publications

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“…The severity of shock can be used to aid in device selection. 76 For example, a patient with more severe CS may be better supported with an Impella 5.5 rather than an Impella CP. For patients with HF-CS with significant concomitant RV dysfunction, hypoxemia, or more severe shock, VA-ECMO may be considered.…”

Section: Escalation Of Tmcs In Patients With Hf-csmentioning

confidence: 99%

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Geller¹,

Sinha²,

Kapur³

et al. 2022

Circulation

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107

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The use of temporary mechanical circulatory support in cardiogenic shock has increased dramatically despite a lack of randomized controlled trials or evidence guiding clinical decision-making. Recommendations from professional societies on temporary mechanical circulatory support escalation and de-escalation are limited. This scientific statement provides pragmatic suggestions on temporary mechanical circulatory support device selection, escalation, and weaning strategies in patients with common cardiogenic shock causes such as acute decompensated heart failure and acute myocardial infarction. The goal of this scientific statement is to serve as a resource for clinicians making temporary mechanical circulatory support management decisions and to propose standardized approaches for their use until more robust randomized clinical data are available.

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Section: Escalation Of Tmcs In Patients With Hf-csmentioning

confidence: 99%

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Geller¹,

Sinha²,

Kapur³

et al. 2022

Circulation

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107

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“…4–6 In the absence of randomized clinical trials, significant clinical practice variations in the acute management of AMI-CS and HF-CS persist, and the comparative outcomes of these 2 types of CS are not well-understood. 7,8…”

mentioning

confidence: 99%

Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes

Sinha

Rosner

Tehrani

et al. 2022

Circ: Heart Failure

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Background: Little is known about clinical characteristics, hospital course, and longitudinal outcomes of patients with cardiogenic shock (CS) related to heart failure (HF-CS) compared to acute myocardial infarction (AMI; CS related to AMI [AMI-CS]). Methods: We examined in-hospital and 1-year outcomes of 520 (219 AMI-CS, 301 HF-CS) consecutive patients with CS (January 3, 2017–December 31, 2019) in a single-center registry. Results: Mean age was 61.5±13.5 years, 71% were male, 22% were Black patients, and 63% had chronic kidney disease. The HF-CS cohort was younger (58.5 versus 65.6 years, P <0.001), had fewer cardiac arrests (15.9% versus 35.2%, P <0.001), less vasopressor utilization (61.8% versus 82.2%, P <0.001), higher pulmonary artery pulsatility index (2.14 versus 1.51, P <0.01), lower cardiac power output (0.64 versus 0.77 W, P <0.01) and higher pulmonary capillary wedge pressure (25.4 versus 22.2 mm Hg, P <0.001) than patients with AMI-CS. Patients with HF-CS received less temporary mechanical circulatory support (34.9% versus 76.3% P <0.001) and experienced lower rates of major bleeding (17.3% versus 26.0%, P= 0.02) and in-hospital mortality (23.9% versus 39.3%, P <0.001). Postdischarge, 133 AMI-CS and 229 patients with HF-CS experienced similar rates of 30-day readmission (19.5% versus 24.5%, P =0.30) and major adverse cardiac and cerebrovascular events (23.3% versus 28.8%, P =0.45). Patients with HF-CS had lower 1-year mortality (n=123, 42.6%) compared to the patients with AMI-CS (n=110, 52.9%, P =0.03). Cumulative 1-year mortality was also lower in patients with HF-CS (log-rank test, P =0.04). Conclusions: Patients with HF-CS were younger, and despite lower cardiac power output and higher pulmonary capillary wedge pressure, less likely to receive vasopressors or temporary mechanical circulatory support. Although patients with HF-CS had lower in-hospital and 1-year mortality, both cohorts experienced similarly high rates of postdischarge major adverse cardiovascular and cerebrovascular events and 30-day readmission, highlighting that both cohorts warrant careful long-term follow-up. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03378739.

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“…It is also the second most common indication for admission to contemporary cardiac intensive care units (CICU's) (3). Moreover, CS is multifactorial; nearly 50% of cases stem from acutely decompensated heart failure (HF), a distinct etiology comprised of varying disease states with equally suboptimal outcomes (4).…”

Section: Introductionmentioning

confidence: 99%

“…While carefully conducted studies are ongoing in the shock field, eligible patients participating in shock trials comprise only one third of the actual CS patient population, thus contributing to knowledge gaps and the current state of clinical equipoise and heterogeneity of treatment in the field (5,6). The lack of progress in the field has also been attributed to gaps in our understanding of the pathophysiology and incomplete phenotyping of the heterogeneity of CS patients (4,7). In the absence of randomized clinical trials to inform clinical decision-making, data is emerging from dedicated North American CS registries supporting an algorithmic and team-based approach to management (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

The Multicenter Collaborative to Enhance Biologic Understanding, Quality, and Outcomes in Cardiogenic Shock (VANQUISH Shock): Rationale and Design

Tehrani¹,

Drakos²,

Billia³

et al. 2022

Canadian Journal of Cardiology

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Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

Abstract: Despite increasing prevalence in critical care units, cardiogenic shock related to HF (HF-CS) is incompletely understood and distinct from acute myocardial infarction related CS. This review highlights the pathophysiology, evaluation, and contemporary management of HF-CS.

Cited by 71 publications

References 110 publications

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes

The Multicenter Collaborative to Enhance Biologic Understanding, Quality, and Outcomes in Cardiogenic Shock (VANQUISH Shock): Rationale and Design

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