Cardiogenic shock (CS) is traditionally considered a perfusion disorder related to
low cardiac output; its severity is classified based on the extent of hemodynamic
instability and end-organ hypoperfusion.
1
,2
However, there is increasing recognition of the prognostic significance of coexisting
congestion, and there is a demonstrated association of certain congestive profiles
with higher in-hospital mortality rates.
3
,4
In CS related to heart failure (or nonacute myocardial infarction [AMI]-related shock),
biventricular congestion was common and was associated with significantly higher mortality
rates than left ventricular (LV)-predominant failure.
3
In AMI shock, early, selective revascularization is associated with a survival benefit
when compared to medical therapy alone.
5
,6
Mortality rates associated with AMI-CS have remained persistently elevated despite
significant advances in revascularization techniques over the past 2 decades, suggesting
a gap in treatment strategies.
7
In recent years, LV unloading prior to coronary reperfusion has been shown to reduce
infarct size and to trigger cardioprotective phenomena in preclinical models.
8
Treatment of congestion has, therefore, become an important therapeutic goal in CS,
regardless of the cause of CS.To read this article in full you will need to make a payment
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References
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- PCI Strategies in patients with acute myocardial infarction and cardiogenic shock.N Engl J Med. 2017; 377: 2419-2432
- Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association.Circulation. 2017; 136 (e232-e68)
- Left ventricular unloading increases the coronary collateral flow index before reperfusion and reduces infarct size in a swine model of acute myocardial infarction.J Am Heart Assoc. 2019; 8e013586
- Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment.Nat Rev Cardiol. 2020; 17: 641-655
- Role of volume redistribution in the congestion of heart failure.J Am Heart Assoc. 2017; 6e006817
- Acute mechanical circulatory support for cardiogenic shock: the “door-to-support” time.F1000Res;. 2017; : 737
- Dynamic invasive hemodynamic congestion profile impacts acute myocardial infarction complicated by cardiogenic shock outcomes: a real-world single-center study.J Card Fail. 2022;xxx:xxx–x;
- Pulmonary artery catheter monitoring in patients with cardiogenic shock: time for a reappraisal?.Card Fail Rev. 2022; 8: e15
- 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2022; 145: e895-1032
- Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.JAMA. 2005; 294: 1625-1633
- The effectiveness of right heart catheterization in the initial care of critically III patients.JAMA. 1996; 276 (–7): 889
Article info
Publication history
Published online: December 16, 2022
Accepted:
December 1,
2022
Received:
December 1,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
