Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype

Zweck, Elric; Kanwar, Manreet; Li, Song; Sinha, Shashank S.; Garan, A.R.; Hernández-Montfort, Jaime; Zhang, Yijing; Li, Borui; Baca, Paulina; Dieng, Fatou; Harwani, Neil; Abraham, Jacob; Hickey, Gavin; Nathan, Sandeep; Wencker, Detlef; Hall, Shelley; Schwartzman, Andrew; Khalife, Wissam; Mahr, Claudius; Kim, Ju H.; Vorovich, Esther; Whitehead, Evan H.; Blumer, Vanessa; Westenfeld, Ralf; Burkhoff, Daniel; Kapur, Navin K.

doi:10.1016/j.jchf.2023.05.007

Cited by 16 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14,17 Zweck et al used consensus k-means clustering to identify three clinical phenotypes on admission in CS patients with different early outcomes. 11,15 The same three CS phenotypes were replicated by Jentzer et al, with differences in 1 year of mortality observed between phenotypes. 16 In contrast to previous studies, our analysis examined host-response biomarkers that provide novel insights into the underlying pathophysiological processes.…”

Section: Discussionmentioning

confidence: 81%

“…14 Previous studies have used a phenotyping approach including variables measured on admission to identify CS clinical phenotypes. 11,15,16 While most of these studies have focused on short-term survival after CS, long-term survival and quality of life are important patient-centred outcomes. 14,17 Zweck et al used consensus k-means clustering to identify three clinical phenotypes on admission in CS patients with different early outcomes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical phenotypes of cardiogenic shock survivors: insights into late host responses and long‐term outcomes

Soussi,

Ahmadiankalati,

Jentzer

et al. 2023

ESC Heart Failure

View full text Add to dashboard Cite

AimsAn elevated risk of adverse events persists for years in cardiogenic shock (CS) survivors with high mortality rate and physical/mental disability. This study aims to link clinical CS‐survivor phenotypes with distinct late host‐response patterns at intensive care unit (ICU) discharge and long‐term outcomes using model‐based clustering.Methods and resultsIn the original prospective, observational, international French and European Outcome Registry in Intensive Care Units (FROG‐ICU) study, ICU patients with CS on admission were identified (N = 228). Among them, 173 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct CS‐survivor phenotypes at ICU discharge using 15 readily available clinical and laboratory variables. The primary endpoint was 1 year of mortality after ICU discharge. Secondary endpoints were readmission and physical/mental disability [short form‐36 questionnaire (SF‐36) score] within 1 year after ICU discharge. Two distinct phenotypes at ICU discharge were identified (A and B). Patients in Phenotype B (38%) were more anaemic and had higher circulating levels of lactate, sustained kidney injury, and persistent elevation in plasma markers of inflammation, myocardial fibrosis, and endothelial dysfunction compared with Phenotype A. They had also a higher rate of non‐ischaemic origin of CS and right ventricular dysfunction on admission. CS survivors in Phenotype B had higher 1 year of mortality compared with Phenotype A (P = 0.045, Kaplan–Meier analysis). When adjusted for traditional risk factors (i.e. age, severity of illness, and duration of ICU stay), Phenotype B was independently associated with 1 year of mortality [adjusted hazard ratio = 2.83 (95% confidence interval 1.21–6.60); P = 0.016]. There was a significantly lower physical quality of life in Phenotype B patients at 3 months (i.e. SF‐36 physical component score).ConclusionsA phenotype with sustained inflammation, myocardial fibrosis, and endothelial dysfunction at ICU discharge was identified from readily available data and was independently associated with poor long‐term outcomes in CS survivors.

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Clinical phenotypes of cardiogenic shock survivors: insights into late host responses and long‐term outcomes

Soussi,

Ahmadiankalati,

Jentzer

et al. 2023

ESC Heart Failure

View full text Add to dashboard Cite

show abstract

“…Aggregate assessments via serial SCAI classification is an independent predictor of mortality [ 10 ] and patients who reach SCAI stage E at any stage during their hospital stay have at least a 2-fold increase in mortality compared to those who reached a maximum SCAI Stage of C or D [ 27 ]. Extending this further, phenotyping patients based on clinical variables on admission classified by a machine learning approach, enriched the prognostic accuracy of SCAI classification, identified a cohort likely to progress towards SCAI stage E and highlighted an association between phenotype and tMCS device [ 28 ]. The use of alternative composite prognostic risk scores, such as the IHVI shock [ 14 ] and CardShock [ 15 ] scores, was deemed uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…The role of IABP as the initial tMCS modality in SCAI C HF-CS as a bridge to recovery or HRT was uncertain. Registry data demonstrate continued use of the IABP across all SCAI stages of HF-CS [ 10 , 11 , 28 ]. Conceptually, the differing physiology of HF-CS with volume and pressure overload as opposed to acute contractile dysfunction may result in comparatively greater afterload reduction and improved organ perfusion [ 34 ], a hypothesis supported by clinical data [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Registry data demonstrate continued use of the IABP across all SCAI stages of HF-CS [ 10 , 11 , 28 ]. Conceptually, the differing physiology of HF-CS with volume and pressure overload as opposed to acute contractile dysfunction may result in comparatively greater afterload reduction and improved organ perfusion [ 34 ], a hypothesis supported by clinical data [ 27 , 28 ]. The role of IABP in the early management of HF-CS compared to vasoactive therapies is currently being assessed in a prospective RCT with a primary end-point of 60-day survival or successful bridge to HRT [ 35 ] (ClinicalTrials.gov Identifier: NCT04369573).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The management of heart failure cardiogenic shock: an international RAND appropriateness panel

Williams,

Kalakoutas,

Olusanya

et al. 2024

Crit Care

View full text Add to dashboard Cite

Background Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. Methods A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1–3 as inappropriate, 4–6 as uncertain and as 7–9 appropriate). Results Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. Conclusion This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.

show abstract

The Price We Pay for Progression in Shock Care: Economic Burden, Accessibility, and Adoption of Shock-Teams and Mechanical Circulatory Support Devices

Vallabhajosyula,

Sinha,

Kochar

et al. 2024

Curr Cardiol Rep

View full text Add to dashboard Cite

Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype

Cited by 16 publications

References 24 publications

Clinical phenotypes of cardiogenic shock survivors: insights into late host responses and long‐term outcomes

Clinical phenotypes of cardiogenic shock survivors: insights into late host responses and long‐term outcomes

The management of heart failure cardiogenic shock: an international RAND appropriateness panel

The Price We Pay for Progression in Shock Care: Economic Burden, Accessibility, and Adoption of Shock-Teams and Mechanical Circulatory Support Devices

Contact Info

Product

Resources

About