Cherbi Miloud, Gerbaud Edouard, Lamblin Nicolas, Bonnefoy Eric, Bonello Laurent, Levy Bruno, Ternacle Julien, Schneider Francis, Elbaz Meyer, Khachab Hadi, Paternot Alexis, Seronde Marie-France, Schurtz Guillaume, Leborgne Laurent, Filippi Emmanuelle, Mansourati Jacques, Genet Thibaud, Harbaoui Brahim, Vanzetto Gérald, Combaret Nicolas, Marchandot Benjamin, Lattuca Benoit, Leurent Guillaume, Puymirat Etienne, Roubille François, Delmas Clément
Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France/ Institute of Metabolic and Cardiovascular Diseases, National Institute of Health and Medical Research (Inserm), Toulouse, France.
Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France/Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Pessac, France.
Am J Cardiol. 2023 Nov 1;206:89-97. doi: 10.1016/j.amjcard.2023.07.153. Epub 2023 Sep 8.
Idiopathic dilated cardiomyopathy (IDCM) is one of the most common forms of nonischemic cardiomyopathy worldwide, possibly leading to cardiogenic shock (CS). Despite this heavy burden, the outcomes of CS in IDCM are poorly reported. Based on a large registry of unselected CS, our aim was to shed light on the 1-year outcomes after CS in patients with and without IDCM. FRENSHOCK was a prospective registry including 772 patients with CS from 49 centers. The 1-year outcomes (rehospitalizations, mortality, heart transplantation [HTx], ventricular assist devices [VAD]) were analyzed and adjusted on independent predictive factors. Within 772 CS included, 78 occurred in IDCM (10.1%). Patients with IDCM had more frequent history of chronic kidney failure and implantable cardioverter-defibrillator implantation. No difference was found in 1-month all-cause mortality between groups (28.2 vs 25.8%for IDCM and others, respectively; adjusted hazard ratio 1.14 [0.73 to 1.77], p = 0.57). Patients without IDCM were more frequently treated with noninvasive ventilation and intra-aortic balloon pump. At 1 year, IDCM led to higher rates of death or cardiovascular rehospitalizations (adjusted odds ratio 4.77 [95% confidence interval 1.13 to 20.1], p = 0.03) and higher rates of HTx or VAD for patients aged <65 years (adjusted odds ratio 2.68 [1.21 to 5.91], p = 0.02). In conclusion, CS in IDCM is a very common scenario and is associated with a higher rate of 1-year death or cardiovascular rehospitalizations and a more frequent recourse to HTx or VAD for patients aged <65 years, encouraging the consideration of it as a red flag for myocardial decline and urging for a closer follow-up and earlier evaluation for advanced heart failure therapies.
特发性扩张型心肌病（IDCM）是全球最常见的非缺血性心肌病形式之一，可能导致心源性休克（CS）。尽管负担沉重，但IDCM中心源性休克的结局报道较少。基于一个大型的未选择的心源性休克登记处，我们的目的是阐明合并和不合并IDCM的患者心源性休克后的1年结局。FRESHOCK是一项前瞻性登记研究，纳入了来自49个中心的772例心源性休克患者。分析了1年结局（再次住院、死亡率、心脏移植[HTx]、心室辅助装置[VAD]）并根据独立预测因素进行了调整。在纳入的772例心源性休克患者中，78例发生于IDCM（10.1%）。IDCM患者有慢性肾衰竭病史和植入式心律转复除颤器植入史的情况更常见。两组间1个月全因死亡率无差异（IDCM组和其他组分别为28.2%和25.8%；调整后风险比1.14[0.73至1.77]，p = 0.57）。非IDCM患者接受无创通气和主动脉内球囊泵治疗的频率更高。在1年时，IDCM导致死亡或心血管再次住院率更高（调整后的优势比4.77[95%置信区间1.13至20.1]，p = 0.03），并且65岁以下患者接受心脏移植或心室辅助装置的比例更高（调整后的优势比2.68[1.21至5.91]，p = 0.02）。总之，IDCM的心源性休克是一种非常常见的情况，与1年死亡或心血管再次住院率较高以及65岁以下患者更频繁地使用心脏移植或心室辅助装置相关，这促使将其视为心肌衰退的警示信号，并敦促对晚期心力衰竭治疗进行更密切的随访和更早的评估。
