Precardiogenic Shock

Singh, Twinkle; Samson, Rohan; Ayinapudi, Karnika; Motwani, Ayush; Jemtel, Thierry H. Le

doi:10.1097/crd.0000000000000237

Cited by 7 publications

(2 citation statements)

References 35 publications

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“…The Society of Cardiovascular Angiography and Interventions (SCAI) has recently proposed the classification of CS into five stages (A to E) to characterize patients for better-targeted treatment [9]. Pre-cardiogenic shock (Pre-CS) refers to the period of rapid hemodynamic deterioration that precedes overt CS with hypotension, inflammatory response, and endorgan damage [10].…”

Section: Introductionmentioning

confidence: 99%

Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abuelazm,

Ali,

AlBarakat

et al. 2023

Diseases

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Istaroxime, an intravenous inotropic agent with a dual mechanism—increasing both cardiomyocyte contractility and relaxation—is a novel treatment for acute heart failure (AHF), the leading cause of morbidity and mortality in heart failure. We conducted a systematic review and meta-analysis that synthesized randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane until 24 April 2023. We used a fixed-effect or random-effect model—according to heterogeneity—to pool dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD), with a 95% confidence interval (CI). We included three RCTs with a total of 300 patients. Istaroxime was significantly associated with an increased left ventricular ejection fraction (mL) (MD: 1.06, 95% CI: 0.29, 1.82; p = 0.007), stroke volume index (MD: 3.04, 95% CI: 2.41, 3.67; p = 0.00001), and cardiac index (L/min/m2) (MD: 0.18, 95% CI: 0.11, 025; p = 0.00001). Also, istaroxime was significantly associated with a decreased E/A ratio (MD: −0.39, 95% CI: −0.58, −0.19; p = 0.0001) and pulmonary artery systolic pressure (mmHg) (MD: 2.30, 95% CI: 3.20, 1.40; p = 0.00001). Istaroxime was significantly associated with increased systolic blood pressure (mmHg) (MD: 5.32, 95% CI: 2.28, 8.37; p = 0.0006) and decreased heart rate (bpm) (MD: −3.05, 95% CI: −5.27, −0.82; p = 0.007). Since istaroxime improved hemodynamic and echocardiographic parameters, it constitutes a promising strategy for AHF management. However, the current literature is limited to a small number of RCTs, warranting further large-scale phase III trials before clinical endorsement.

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Section: Introductionmentioning

confidence: 99%

Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abuelazm,

Ali,

AlBarakat

et al. 2023

Diseases

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“…The crucial step in early CS recognition is awareness of the clinical and hemodynamic deterioration that precedes CS. 5 Proponents of the CS classification in 5 stages did emphasize the importance of the hemodynamic state that precedes the state of CS. 6 Hypotensive patients without evidence of hypoperfusion (pre-shock) had lower in-hospital mortality than patients with hypotension and hypoperfusion (shock).…”

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Early Mechanical Circulatory Support for Cardiogenic Shock

Upadhrasta

Museedi

Thannoun

et al. 2022

Cardiology in Review

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Reversal of cardiogenic shock depends on its early recognition and prompt initiation of therapy. Recognition of the clinical and hemodynamic deterioration that precedes cardiogenic shock is a crucial step in its early detection. Treatment of pre-cardiogenic shock is chiefly pharmacologic with intravenous administration of pressor, inotropic, and loop diuretic agents. Failure to reverse the preshock state with pharmacotherapy entails progression to cardiogenic shock and the need for prompt mechanical circulatory support with membrane oxygenation and possibly left ventricular decompression.

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Safety and efficacy of istaroxime in patients with acute heart failure‐related pre‐cardiogenic shock – a multicentre, randomized, double‐blind, placebo‐controlled, parallel group study (SEISMiC)

Metra

Chioncel

Cotter

et al. 2022

European J of Heart Fail

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Aims We examined the effects of istaroxime in patients hospitalized for acute heart failure (AHF) related Society for Cardiovascular Angiography and Interventions (SCAI) stage B pre‐cardiogenic shock (CS). Methods and results Sixty patients with AHF without acute myocardial infarction with pre‐CS, defined as systolic blood pressure (SBP) <90 mmHg without hypoperfusion, venous lactate ≥2 mmol/L and/or mechanical or inotropic support, were randomized to istaroxime 1.0–1.5 μg/kg/min or placebo for 24 h. The primary endpoint, the adjusted area under the curve (AUC) change in SBP from time of treatment to 6 h, was 53.1 (standard error [SE] 6.88) mmHg × hour versus 30.9 (SE 6.76) mmHg × hour with istaroxime versus placebo (p = 0.017). Adjusted SBP AUC at 24 h was 291.2 (SE 27.5) versus 208.7 (SE 27.0) mmHg × hour (p = 0.025). At 24 h, some echocardiographic measurements improved with istaroxime versus placebo including cardiac index (+0.21 L/min/m2; p = 0.016), left atrial area (−1.8 cm2; p = 0.008), and left ventricular end‐systolic volume (−12.0 ml; p = 0.034). There were no significant differences in pulse pressure, laboratory measurements, serious adverse events or adverse events between the treatment groups except for more nausea, vomiting and infusion site pain in the istaroxime‐treated patients. In a post‐hoc analysis, patients receiving ≤1.0 μg/kg/min versus 1.5 μg/kg/min had similar increase in blood pressure, but a trend towards less adverse events. Conclusion In a phase 2a study of patients with AHF related pre‐CS, istaroxime improved blood pressure and some echocardiography measures related to heart failure and was well tolerated.

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Precardiogenic Shock

Cited by 7 publications

References 35 publications

Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Early Mechanical Circulatory Support for Cardiogenic Shock

Safety and efficacy of istaroxime in patients with acute heart failure‐related pre‐cardiogenic shock – a multicentre, randomized, double‐blind, placebo‐controlled, parallel group study (SEISMiC)

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