Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania.
Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Heart Lung Transplant. 2024 Feb;43(2):189-203. doi: 10.1016/j.healun.2023.09.014. Epub 2023 Dec 8.
In recent years, there have been significant advancements in the understanding, risk-stratification, and treatment of cardiogenic shock (CS). Despite improved pharmacologic and device-based therapies for CS, short-term mortality remains as high as 50%. Most recent efforts in research have focused on CS related to acute myocardial infarction, even though heart failure related CS (HF-CS) accounts for >50% of CS cases. There is a paucity of high-quality evidence to support standardized clinical practices in approach to HF-CS. In addition, there is an unmet need to identify disease-specific diagnostic and risk-stratification strategies upon admission, which might ultimately guide the choice of therapies, and thereby improve outcomes and optimize resource allocation. The heterogeneity in defining CS, patient phenotypes, treatment goals and therapies has resulted in difficulty comparing published reports and standardized treatment algorithms. An International Society for Heart and Lung Transplantation (ISHLT) consensus conference was organized to better define, diagnose, and manage HF-CS. There were 54 participants (advanced heart failure and interventional cardiologists, cardiothoracic surgeons, critical care cardiologists, intensivists, pharmacists, and allied health professionals), with vast clinical and published experience in CS, representing 42 centers worldwide. State-of-the-art HF-CS presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues, including but not limited to models of CS care delivery, patient presentations in HF-CS, and strategies in HF-CS management. This consensus report summarizes the contemporary literature review on HF-CS presented in the first half of the conference (part 1), while the accompanying document (part 2) covers the breakout sessions where the previously agreed upon clinical issues were discussed with an aim to get to a consensus.
近年来，人们对心源性休克（CS）的认识、风险分层和治疗方法有了重大进展。尽管 CS 的药物和器械治疗有所改善，但短期死亡率仍高达 50%。最近的研究工作主要集中在心梗相关的 CS 上，尽管心衰相关 CS（HF-CS）占 CS 病例的 50%以上。在 HF-CS 的治疗方法方面，缺乏支持标准化临床实践的高质量证据。此外，需要确定入院时针对特定疾病的诊断和风险分层策略，这可能最终指导治疗方法的选择，从而改善预后并优化资源分配。CS 的定义、患者表型、治疗目标和治疗方法的异质性导致难以比较已发表的报告和标准化治疗算法。国际心肺移植协会（ISHLT）组织了一次共识会议，以更好地定义、诊断和管理 HF-CS。共有 54 名参与者（心力衰竭和介入心脏病专家、心胸外科医生、心脏重症监护专家、重症监护医师、药剂师和相关健康专业人员）参加了会议，他们在 CS 方面具有广泛的临床和发表经验，代表了全球 42 个中心。会议首先介绍了心衰相关 CS 的最新研究成果，随后进行了分组讨论，旨在就各种问题达成共识，包括但不限于 CS 护理模式、HF-CS 患者表现以及 HF-CS 管理策略。本共识报告总结了会议上介绍的 HF-CS 的当代文献综述（第 1 部分），而随附的文件（第 2 部分）涵盖了分组讨论，这些讨论旨在就先前商定的临床问题达成共识。
