Møller Jacob Eifer, Hassager Christian, Proudfoot Alastair, De Backer Daniel, Morrow David A, Ravn Hanne Berg, Krychtiuk Konstantin A, Zeymer Uwe, Thiele Holger
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Odense University Hospital, Denmark and Clinical Institute, Southern Denmark University, Odense, Denmark.
Intensive Care Med. 2025 Aug 6. doi: 10.1007/s00134-025-08049-y.
Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion caused by primary cardiac failure, in which the heart cannot generate sufficient output despite adequate preload and is associated with very high mortality rates. The emergence of precision medicine may enable tailored interventions based on individual patient profiles, including genetic, biomarker, imaging, and clinical data. Advanced hemodynamic monitoring, mechanical circulatory support devices with smaller profiles and higher flow, and targeted pharmacologic therapies have expanded the therapeutic possibilities in CS. However, integrating these novel approaches into clinical practice requires careful alignment with evidence-based medicine. Balancing innovation with robust clinical evidence is crucial. Many technologies enter the clinical sphere before comprehensive trials confirm their benefit, creating potential risks in vulnerable CS patients. Precision medicine must therefore be grounded on rigorous data from randomized-controlled trials, registries, and meta-analyses to ensure safety and efficacy. Collaborative efforts, including large-scale data sharing and international research networks, are essential to bridge the gap between innovation and evidence. The goal is to move beyond a one-size-fits-all model toward a more nuanced, patient-centered approach while maintaining scientific rigor.
心源性休克（CS）是一种由原发性心力衰竭导致的严重终末器官灌注不足状态，在此状态下，尽管有足够的前负荷，心脏仍无法产生足够的心输出量，且死亡率极高。精准医学的出现或许能够基于个体患者资料（包括基因、生物标志物、影像学和临床数据）进行针对性干预。先进的血流动力学监测、外形更小且流量更高的机械循环支持设备以及靶向药物治疗，拓展了心源性休克的治疗可能性。然而，将这些新方法融入临床实践需要与循证医学仔细接轨。在创新与有力的临床证据之间取得平衡至关重要。许多技术在全面试验证实其益处之前就进入了临床领域，给脆弱的心源性休克患者带来了潜在风险。因此，精准医学必须基于来自随机对照试验、登记处和荟萃分析的严格数据，以确保安全性和有效性。包括大规模数据共享和国际研究网络在内的合作努力对于弥合创新与证据之间的差距至关重要。目标是在保持科学严谨性的同时，超越一刀切的模式，走向更细致入微、以患者为中心的方法。
