Criteria for Defining Stages of Cardiogenic Shock Severity

Kapur, Navin K.; Kanwar, Manreet; Sinha, Shashank S.; Thayer, Katherine; 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; Li, Song; Mahr, Claudius; Kim, Ju H.; Vorovich, Esther; Whitehead, Evan H.; Blumer, Vanessa; Burkhoff, Daniel

doi:10.1016/j.jacc.2022.04.049

Cited by 114 publications

(119 citation statements)

References 22 publications

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“…In the study of Kapur et al lactic acid levels were also added to the classification criteria for cardiogenic shock. Therefore, we speculate that blood lactic acid is a very useful clinical parameter for assessing the severity and prognosis of AHF [ 25 ]. The association between NT-proBNP and in-hospital all-cause rate was finally identified as a nearly inverse L-shaped curve.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Arterial Blood Lactic Acid Concentration on the Risk of in-Hospital All-Cause Death in Patients with Acute Heart Failure

Yuan

Wang

et al. 2022

International Journal of Clinical Practice

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The study aims to examine the predictive value of arterial blood lactic acid concentration for in-hospital all-cause mortality in the intensive care unit (ICU) for patients with acute heart failure (AHF). We retrospectively analyzed the clinical data of 7558 AHF patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The exposure variable of the present study was arterial blood lactic acid concentration and the outcome variable was in-hospital all-cause death. The patients were divided into those who survived (n = 6792) and those who died (n = 766). The multivariate logistic regression model, restricted cubic spline (RCS) plot, and subgroup analysis were used to evaluate the association between lactic acid and in-hospital all-cause mortality. In addition, receiver operating curve (ROC) analysis also was performed. Finally, we further explore the association between NT-proBNP and lactic acid and in-hospital all-cause mortality. Compared with the lowest quartiles, the odds ratios with 95% confidence intervals for in-hospital all-cause mortality across the quartiles were 1.46 (1.07–2.00), 1.48 (1.09–2.00), and 2.36 (1.73–3.22) for lactic acid, and in-hospital all-cause mortality was gradually increased with lactic acid levels increasing ( P for trend <0.05). The RCS plot revealed a positive and linear connection between lactic acid and in-hospital all-cause mortality. A combination of lactic acid concentration and the Simplified Acute Physiology Score (SAPS) II may improve the predictive value of in-hospital all-cause mortality in patients with AHF (AUC = 0.696). Among subgroups, respiratory failure interacted with an association between lactic acid and in-hospital all-cause mortality ( P for interaction <0.05). The correlation heatmap revealed that NT-proBNP was positively correlated with lactic acid (r = 0.07) and positively correlated with in-hospital all-cause mortality (r = 0.18). There was an inverse L-shaped curve relationship between NT-proBNP and in-hospital all-cause mortality, respectively. Mediation analysis suggested that a positive relationship between lactic acid and in-hospital all-cause death was mediated by NT-proBNP. For AHF patients in the ICU, the arterial blood lactic acid concentration during hospitalization was a significant independent predictor of in-hospital all-cause mortality. The combination of lactic acid and SAPS II can improve the predictive value of the risk of in-hospital all-cause mortality in patients with AHF.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of Arterial Blood Lactic Acid Concentration on the Risk of in-Hospital All-Cause Death in Patients with Acute Heart Failure

Yuan

Wang

et al. 2022

International Journal of Clinical Practice

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“…[8]. Criteria for the SCAI stages have been described recently [9] (Table 1). Conceptually, SCAI profiles C, D, and E correspond to INTERMACS 3, 2, and 1, respectively.…”

Section: Hemodynamic Phenotyping Of Cardiogenic Shockmentioning

confidence: 99%

“…The SCAI classification is associated with short term clinical outcomes in patients with CS [ 8 ]. Criteria for the SCAI stages have been described recently [ 9 ] (Table 1 ). Conceptually, SCAI profiles C, D, and E correspond to INTERMACS 3, 2, and 1, respectively.…”

Section: Hemodynamic Phenotyping Of Cardiogenic Shockmentioning

confidence: 99%

Phenotyping and Hemodynamic Assessment in Cardiogenic Shock: From Physiology to Clinical Application

Lim

2022

Cardiol Ther

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There is growing interest in invasive hemodynamic assessment in cardiogenic shock, primarily due to the widespread adoption of mechanical circulatory support (MCS). Invasive hemodynamic assessment is central to two aspects of cardiogenic shock management: (1) the phenotyping of cardiogenic shock, and (2) the assessment of response to therapy. Phenotyping of cardiogenic shock serves to guide timely therapeutic intervention, and the assessment of hemodynamic response to therapy directs the escalation or de-escalation of therapy, including MCS. This review aims to discuss these two aspects of hemodynamic assessment in cardiogenic shock. Firstly, the physiologic underpinnings of a phenotyping schema, and the implication of the cardiogenic shock phenotype on the MCS strategy in cardiogenic shock will be discussed. Secondly, the concept of cardiac power output and 'effective' oxygen delivery will be discussed in relation to hemodynamic response to therapy in cardiogenic shock.

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“…60 The CS working group has proposed a further modification to the SCAI stages such that hypoperfusion alone, as evidenced by biochemical markers in the absence of hypotension, may adequately identify patients in SCAI Stage B before they worsen. 61 The most optimal assessment of incident or underlying renal dysfunction in CS as well as optimal timing for initiation of renal replacement therapy remains elusive. Similarly, goals for mean arterial pressure, lactate clearance, and mechanical ventilation all have insufficient supporting evidence.…”

Section: Moving Targets Of the Futurementioning

confidence: 99%

Reflecting on the advancements of HFrEF therapies over the last two decades and predicting what is yet to come

Piña

Gibson

Zieroth

et al. 2022

European Heart Journal Supplements

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What was once considered a topic best avoided, managing heart failure with reduced ejection fraction (HFrEF) has become the focus of many drug and device therapies. While the four pillars of guideline-directed medical therapies have successfully reduced heart failure hospitalizations, and some have even impacted cardiovascular mortality in randomized controlled trials (RCTs), patient-reported outcomes have emerged as important endpoints that merit greater emphasis in future studies. The prospect of an oral inotrope seems more probable now as targets for drug therapies have moved from neurohormonal modulation to intracellular mechanisms and direct cardiac myosin stimulation. While we have come a long way in safely providing durable mechanical circulatory support to patients with advanced HFrEF, several percutaneous device therapies have emerged, and many are under investigation. Biomarkers have shown promise in not only improving our ability to diagnose incident heart failure but also our potential to implicate specific pathophysiological pathways. The once-forgotten concept of discordance between pressure and volume, the forgotten splanchnic venous and lymphatic compartments, have all emerged as promising targets for diagnosing and treating heart failure in the not-so-distant future. The increase in heart failure-related cardiogenic shock (CS) has revived interest in defining optimal perfusion targets and designing RCTs in CS. Rapid developments in remote monitoring, telemedicine, and artificial intelligence promise to change the face of heart failure care. In this state-of-the-art review, we reminisce about the past, highlight the present, and predict what might be the future of HFrEF therapies.

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Criteria for Defining Stages of Cardiogenic Shock Severity

Cited by 114 publications

References 22 publications

Predictive Value of Arterial Blood Lactic Acid Concentration on the Risk of in-Hospital All-Cause Death in Patients with Acute Heart Failure

Predictive Value of Arterial Blood Lactic Acid Concentration on the Risk of in-Hospital All-Cause Death in Patients with Acute Heart Failure

Phenotyping and Hemodynamic Assessment in Cardiogenic Shock: From Physiology to Clinical Application

Reflecting on the advancements of HFrEF therapies over the last two decades and predicting what is yet to come

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