Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype

Authors

Elric Zweck, The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
Manreet Kanwar, Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Song Li, University of Washington Medical Center, Seattle, Washington, USA.
Shashank S. Sinha, Inova Heart and Vascular Institute, Inova Fairfax Campus, Falls Church, Virginia, USA.
A Reshad Garan, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Jaime Hernandez-Montfort, Baylor Scott and White Health, Advanced Heart Failure Program Clinic, Temple, Texas, USA.
Andrew Schwartzman, Maine Medical CenterFollow

Document Type

Article

Publication Date

6-6-2023

Institution/Department

Cardiology

Journal Title

JACC. Heart failure

Abstract

BACKGROUND: Cardiogenic shock (CS) patients remain at 30% to 60% in-hospital mortality despite therapeutic innovations. Heterogeneity of CS has complicated clinical trial design. Recently, 3 distinct CS phenotypes were identified in the CSWG (Cardiogenic Shock Working Group) registry version 1 (V1) and external cohorts: I, "noncongested;" II, "cardiorenal;" and III, "cardiometabolic" shock. OBJECTIVES: The aim was to confirm the external reproducibility of machine learning-based CS phenotypes and to define their clinical course. METHODS: The authors included 1,890 all-cause CS patients from the CSWG registry version 2. CS phenotypes were identified using the nearest centroids of the initially reported clusters. RESULTS: Phenotypes were retrospectively identified in 796 patients in version 2. In-hospital mortality rates in phenotypes I, II, III were 23%, 41%, 52%, respectively, comparable to the initially reported 21%, 45%, and 55% in V1. Phenotype-related demographic, hemodynamic, and metabolic features resembled those in V1. In addition, 58.8%, 45.7%, and 51.9% of patients in phenotypes I, II, and III received mechanical circulatory support, respectively (P = 0.013). Receiving mechanical circulatory support was associated with increased mortality in cardiorenal (odds ratio [OR]: 1.82 [95% CI: 1.16-2.84]; P = 0.008) but not in noncongested or cardiometabolic CS (OR: 1.26 [95% CI: 0.64-2.47]; P = 0.51 and OR: 1.39 [95% CI: 0.86-2.25]; P = 0.18, respectively). Admission phenotypes II and III and admission Society for Cardiovascular Angiography and Interventions stage E were independently associated with increased mortality in multivariable logistic regression compared to noncongested "stage C" CS (P < 0.001). CONCLUSIONS: The findings support the universal applicability of these phenotypes using supervised machine learning. CS phenotypes may inform the design of future clinical trials and enable management algorithms tailored to a specific CS phenotype.

Recommended Citation

Zweck E, Kanwar M, Li S, et al. Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype [published online ahead of print, 2023 Jun 6]. JACC Heart Fail. 2023;S2213-1779(23)00239-1. doi:10.1016/j.jchf.2023.05.007