Περίληψη:
Cardiogenic shock (CS) is a complex multifactorial clinical syndrome with extremely high mortality, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large spectrum of CS presentations resulting from the interaction between an acute cardiac insult and a patient's underlying cardiac and overall medical condition. Phenotyping patients with CS may have clinical impact on management because classification would support initiation of appropriate therapies. CS management should consider appropriate organization of the health care services, and therapies must be given to the appropriately selected patients, in a timely manner, whilst avoiding iatrogenic harm. Although several consensus-driven algorithms have been proposed, CS management remains challenging and substantial investments in research and development have not yielded proof of efficacy and safety for most of the therapies tested, and outcome in this condition remains poor. Future studies should consider the identification of the new pathophysiological targets, and high-quality translational research should facilitate incorporation of more targeted interventions in clinical research protocols, aimed to improve individual patient outcomes. Designing outcome clinical trials in CS remains particularly challenging in this critical and very costly scenario in cardiology, but information from these trials is imperiously needed to better inform the guidelines and clinical practice. The goal of this review is to summarize the current knowledge concerning the definition, epidemiology, underlying causes, pathophysiology and management of CS based on important lessons from clinical trials and registries, with a focus on improving in-hospital management. © 2020 European Society of Cardiology
Συγγραφείς:
Chioncel, O.
Parissis, J.
Mebazaa, A.
Thiele, H.
Desch, S.
Bauersachs, J.
Harjola, V.-P.
Antohi, E.-L.
Arrigo, M.
Gal, T.B.
Celutkiene, J.
Collins, S.P.
DeBacker, D.
Iliescu, V.A.
Jankowska, E.
Jaarsma, T.
Keramida, K.
Lainscak, M.
Lund, L.H.
Lyon, A.R.
Masip, J.
Metra, M.
Miro, O.
Mortara, A.
Mueller, C.
Mullens, W.
Nikolaou, M.
Piepoli, M.
Price, S.
Rosano, G.
Vieillard-Baron, A.
Weinstein, J.M.
Anker, S.D.
Filippatos, G.
Ruschitzka, F.
Coats, A.J.S.
Seferovic, P.
Λέξεις-κλειδιά:
fibrinolytic agent; hypertensive factor; inotropic agent, Article; assisted circulation; cardiogenic shock; cardiovascular risk; echocardiography; electrocardiogram; heart muscle revascularization; heart right ventricle failure; hemodynamic monitoring; hospital discharge; human; incidence; intensive care unit; kidney failure; liver injury; malignant neoplasm; multidisciplinary team; myocarditis; non ST segment elevation myocardial infarction; nonhuman; out of hospital cardiac arrest; pathophysiology; peripartum cardiomyopathy; prevalence; priority journal; prognosis; risk assessment; risk stratification; ST segment elevation myocardial infarction; takotsubo cardiomyopathy; thermoregulation; thorax radiography; valvular heart disease; cardiogenic shock; cardiology; consensus; heart failure; register, Cardiology; Consensus; Heart Failure; Humans; Registries; Shock, Cardiogenic
