Clinical Presentation and In-Hospital Trajectory of Heart Failure and Cardiogenic Shock

Hernández-Montfort, Jaime; Kanwar, Manreet; Sinha, Shashank S.; Garan, A.R.; Blumer, Vanessa; Kataria, Rachna; Whitehead, Evan H.; Yin, Michael T.; Li, Borui; Zhang, Yijing; Thayer, Katherine; Baca, Paulina; Dieng, Fatou; Harwani, Neil; Guglin, Maya; Abraham, Jacob; Hickey, Gavin; Nathan, Sandeep; Wencker, Detlef; Hall, Shelley; Schwartzman, Andrew; Khalife, Wissam; Li, Song; Mahr, Claudius; Vorovich, Esther; Pahuja, Mohit; Burkhoff, Daniel; Kapur, Navin K.

doi:10.1016/j.jchf.2022.10.002

Cited by 33 publications

(36 citation statements)

References 16 publications

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“…The characteristics of this patient group (i.e., more dilated LVs, more severe mitral regurgitation) may render them more amenable to IABP-mediated afterload reduction, as opposed to de novo HF patients. 33 In our patients, RV-CPI did not increase after IABP, mainly due to mean PA pressure decrease. The latter was more evident in responders, implying that afterload reduction partly explains RV optimization with IABP support.…”

Section: Discussionmentioning

confidence: 41%

Prospective Phenotyping of Right Ventricle Function Following Intra-Aortic Balloon Pump Counterpulsation in Left Ventricular Assist Device Candidates: Outcomes and Predictors of Response

et al. 2023

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Intra-aortic balloon pump (IABP) may be applied to optimize advanced heart failure (AHF) patients and improve right ventricular (RV) function before left ventricular assist device (LVAD) implantation. We aimed to evaluate the outcome of this intervention and define RV response predictors. Decompensated AHF patients, not eligible for LVAD because of poor RV function, who required IABP for stabilization were enrolled. Echocardiography and invasive hemodynamics were serially applied to determine fulfillment of prespecified “LVAD eligibility RV function” criteria (right atrium pressure [RA] <12 mm Hg, pulmonary artery pulsatility index [PAPi] >2.00, RA/pulmonary capillary wedge pressure [PCWP] <0.67, RV strain <−14.0%). Right ventricular–free wall tissue was harvested to assess interstitial fibrosis. Eighteen patients (12 male), aged 38 ± 14 years were supported with IABP for 55 ± 51 (3–180) days. In 11 (61.1%), RV improved and fulfilled the prespecified criteria, while seven (38.9%) showed no substantial improvement. Histopathology revealed an inverse correlation between RV interstitial fibrosis and functional benefit following IABP: interstitial fibrosis correlated with post-IABP RA (r = 0.63, p = 0.037), RA/PCWP (r = 0.87, p = 0.001), PAPi (r = −0.83, p = 0.003). Conclusively, IABP improves RV function in certain AHF patients facilitating successful LVAD implantation. Right ventricular interstitial fibrosis quantification may be applied to predict response and guide preoperative patient selection and optimization. http://links.lww.com/ASAIO/A995

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Section: Discussionmentioning

confidence: 41%

Prospective Phenotyping of Right Ventricle Function Following Intra-Aortic Balloon Pump Counterpulsation in Left Ventricular Assist Device Candidates: Outcomes and Predictors of Response

et al. 2023

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“…Patients with HF-CS should be further subcategorized into those with de novo HF-CS related to acute myocardial dysfunction that is known or suspected to be new in onset versus those with acute-on-chronic HF-CS who present with an acute decompensation of chronic HF. 28 For completeness of categorization, patients with newly discovered myocardial dysfunction without sufficient data to determine duration can be classified as being of "unknown chronicity. "…”

Section: Ami-cs Includes Patients With the Onset Of Cs Related To Acu...mentioning

confidence: 99%

Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC)

Waksman,

Pahuja,

van Diepen

et al. 2023

Circulation

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The Shock Academic Research Consortium is a multi-stakeholder group, including representatives from the US Food and Drug Administration and other government agencies, industry, and payers, convened to develop pragmatic consensus definitions useful for the evaluation of clinical trials enrolling patients with cardiogenic shock, including trials evaluating mechanical circulatory support devices. Several in-person and virtual meetings were convened between 2020 and 2022 to discuss the need for developing the standardized definitions required for evaluation of mechanical circulatory support devices in clinical trials for cardiogenic shock patients. The expert panel identified key concepts and topics by performing literature reviews, including previous clinical trials, while recognizing current challenges and the need to advance evidence-based practice and statistical analysis to support future clinical trials. For each category, a lead (primary) author was assigned to perform a literature search and draft a proposed definition, which was presented to the subgroup. These definitions were further modified after feedback from the expert panel meetings until a consensus was reached. This manuscript summarizes the expert panel recommendations focused on outcome definitions, including efficacy and safety.

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Section: Key Pointsmentioning

confidence: 99%

“…Through subsequent study and clinical application, it became apparent that that the defined stages of shock severity were actually more nuanced with gradations in shock severity, and studies showed the utility of re-profiling patients as they either improved or worsened in shock severity [46,58]. In 2022, SCAI convened a new writing group with some of the initial participants and others reflecting the broad application of the classification system, with the goal of determining whether the original SCAI Classification was valid and whether modifications to the construct were appropriate [59].…”

Section: The Society For Cardiac Angiography and Intervention Classif...mentioning

confidence: 99%

The changing face of cardiogenic shock: definitions, epidemiology, and severity assessment

Jentzer

Baran

2023

Current Opinion in Critical Care

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Purpose of review Cardiogenic shock (CS) has been recognized for >50 years, most commonly in the setting of myocardial infarction. This review covers recent advances in the definitions, epidemiology and severity assessment of cardiogenic shock. Recent findings In this review, the authors discuss the evolving definitions of cardiogenic shock, detailing the early approaches as well as more contemporary ideas. The epidemiology of CS is reviewed and then granular detail on the assessment of shock severity is provided including the role of lactate measurement and invasive hemodynamic assessment. The development of the Society for Cardiac Angiography and Intervention (SCAI) consensus statement on Classification of Cardiogenic Shock is reviewed by the principal authors. The revised SCAI Shock document is reviewed as well and the future directions for assessment of shock along with clinical applications are reviewed. Summary Cardiogenic shock mortality has not changed in a significant way in many years. Recent advances such as more granular assessment of shock severity have the potential to improve outcomes by allowing research to separate the patient groups which may respond differently to various therapies.

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Clinical Presentation and In-Hospital Trajectory of Heart Failure and Cardiogenic Shock

Cited by 33 publications

References 16 publications

Prospective Phenotyping of Right Ventricle Function Following Intra-Aortic Balloon Pump Counterpulsation in Left Ventricular Assist Device Candidates: Outcomes and Predictors of Response

Prospective Phenotyping of Right Ventricle Function Following Intra-Aortic Balloon Pump Counterpulsation in Left Ventricular Assist Device Candidates: Outcomes and Predictors of Response

Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC)

The changing face of cardiogenic shock: definitions, epidemiology, and severity assessment

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