Understanding cardiogenic shock

Rudiger, Alain

doi:10.1002/ejhf.265

Cited by 13 publications

(8 citation statements)

References 7 publications

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“…This result was similar to results obtained in the SHOCK trial (4,15). However, the present results differed from those of previously published studies (1,17–19) suggesting that mitral regurgitation is an independent factor for mortality in patients (derived from institutional records) with cardiogenic shock. Collectively, the present study suggests that mitral regurgitation is a marker of worse prognosis for patients with cardiogenic shock.…”

Section: Discussioncontrasting

confidence: 99%

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Transthoracic echocardiography compared with coronary angiography for patients with cardiogenic shock: A prospective cohort study

Chen

Hao³

et al. 2019

Exp Ther Med

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Cardiogenic shock is the most severe form of acute heart failure. The aim of the current study was to investigate correlations between diagnostic parameters and the estimated ejection fraction in patients with cardiogenic shock. A total of 2,445 patients with acute myocardial infarction were subjected to coronary angiograms and standard 2D transthoracic echocardiography. Information for culprit vessel(s) and mitral regurgitation were collected. The Spearman's correlation test was used to assess the correlation between diagnostic parameters and estimated ejection fractions at a 95% confidence level. The angiographically-derived numbers of culprit vessels had a significant correlation with mitral regurgitation (r=0.907; P=0.034). The echocardiographically-derived mitral regurgitation was significantly correlated with the numbers of culprit vessels (r=0.896; P=0.04). Positive correlation was established between angiographically- and echocardiographically-measured left ventricular ejection fraction (r=0.356; P=0.045). The numbers of culprit vessels (P=0.058) and mitral regurgitation (r=0.99; P=0.001) were similar for angiography and echocardiography. Echocardiography- and angiography-derived results were correlated with the estimated ejection fractions of patients with cardiogenic shock. However, there is a substantial difference in the procedures of the two operational techniques.

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Section: Discussioncontrasting

confidence: 99%

“…Cardiogenic shock is the most severe form of acute heart disease (1). Optimal revascularization strategies for patients with cardiogenic shock are complex (2) as the majority of patients with cardiogenic shock have multi-vessel disease (3).…”

Section: Introductionmentioning

confidence: 99%

Transthoracic echocardiography compared with coronary angiography for patients with cardiogenic shock: A prospective cohort study

Chen

Hao³

et al. 2019

Exp Ther Med

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“…In the CardShock study, confusion, elevated blood lactate and a reduced glomerular filtration rate (GFR) were significant predictors of in‐hospital mortality . Of note, excessive diuretic therapy may reduce cardiac preload, thereby diminishing stroke volume and contributing to the shock state iatrogenically …”

Section: Haemodynamic Mechanisms Of Organ Injurymentioning

confidence: 99%

“…The neurohormonal and inflammatory response to systemic congestion and/or peripheral hypoperfusion, if present, may further contribute to organ injury . Neurohormones, oxidative stress and inflammation may also impair the structure and function of the endothelial glycocalyx (eGC) that is composed of glycosaminoglycan (GAG) networks .…”

Section: Haemodynamic Mechanisms Of Organ Injurymentioning

confidence: 99%

Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Harjola

Mullens

Banaszewski

et al. 2017

European J of Heart Fail

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289

256

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Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.

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“…11 Hypoperfusion manifests only in the most severe forms of AHF (cardiogenic shock) in the presence of severely impaired cardiac output. 12 In patients without a previous history of symptomatic heart failure (de novo AHF), AHF mostly occurs secondary to a sudden deterioration in cardiac function -due to myocardial infarction, severe myocarditis or acute valve regurgitation, for example -causing fluid redistribution and, in severe forms, peripheral hypoperfusion. 3 These patients have no or only minor increases in body weight before hospital admission.…”

Section: Pathophysiologymentioning

confidence: 99%

Optimising Heart Failure Therapies in the Acute Setting

Arrigo¹,

Nijst²,

Rudiger³

2018

Cardiac Failure Review

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Acute heart failure (AHF) is a life-threatening condition requiring immediate treatment. The initial therapy should take into account the clinical presentation, pathophysiology at play, precipitating factors and underlying cardiac pathology. Particular attention should be given to polymorbidity and the avoidance of potential iatrogenic harm. Patient preferences and ethical issues should be integrated into the treatment plan at an early stage. The average survival of AHF patients is 2 years and the most vulnerable period is the 3-month time window directly after discharge. Reducing both persistent subclinical congestion and underutilisation of disease-modifying heart failure therapies as well as ensuring optimal transitions of care after hospital discharge are essential in improving outcomes for AHF patients.

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Understanding cardiogenic shock

Cited by 13 publications

References 7 publications

Transthoracic echocardiography compared with coronary angiography for patients with cardiogenic shock: A prospective cohort study

Transthoracic echocardiography compared with coronary angiography for patients with cardiogenic shock: A prospective cohort study

Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Optimising Heart Failure Therapies in the Acute Setting

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