Tufts Medical Center, Boston, Massachusetts, US.
Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, US.
Methodist Debakey Cardiovasc J. 2024 Aug 20;20(4):64-75. doi: 10.14797/mdcvj.1383. eCollection 2024.
The overarching goal of cardiogenic shock (CS) therapy is ensuring long-term survival. In recent years, increasing emphasis has been placed on analyzing mechanisms to improve outcomes in CS. This includes averting in-hospital mortality, modifying the disease process by promoting heart recovery while avoiding multiorgan failure, and circumventing complications related to both CS and treatment strategies deployed to treat CS. Heart replacement therapies represent a viable strategy for long-term survival but are restricted to a small, select percentage of patients. In this review we focus on pathophysiology of the shock state, with an emphasis on addressing reversible etiologies contributing to the decompensated state, optimizing physiological factors for recovery, and identifying therapeutic targets to promote recovery. We also review the known predictors of myocardial recovery, regardless of the etiology of CS. Lastly, we highlight the current gaps in knowledge in this field and support additional high-quality studies focusing on myocardial recovery in CS.
心源性休克（CS）治疗的首要目标是确保长期生存。近年来，人们越来越重视分析机制，以改善 CS 的预后。这包括避免院内死亡率，通过促进心脏恢复来改变疾病进程，同时避免多器官衰竭，以及避免与 CS 相关的并发症和用于治疗 CS 的治疗策略所带来的并发症。心脏替代疗法是实现长期生存的可行策略，但仅限于一小部分选择的患者。在这篇综述中，我们重点关注休克状态的病理生理学，强调解决导致失代偿状态的可逆病因，优化恢复的生理因素，并确定促进恢复的治疗靶点。我们还回顾了已知的心肌恢复预测因素，无论 CS 的病因如何。最后，我们强调了该领域目前存在的知识差距，并支持开展更多关注 CS 中心肌恢复的高质量研究。
