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Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype.
Zweck, Elric; Kanwar, Manreet; Li, Song; Sinha, Shashank S; Garan, A Reshad; Hernandez-Montfort, Jaime; Zhang, Yijing; Li, Borui; Baca, Paulina; Dieng, Fatou; Harwani, Neil M; Abraham, Jacob; Hickey, Gavin; Nathan, Sandeep; Wencker, Detlef; Hall, Shelley; Schwartzman, Andrew; Khalife, Wissam; Mahr, Claudius; Kim, Ju H; Vorovich, Esther; Whitehead, Evan H; Blumer, Vanessa; Westenfeld, Ralf; Burkhoff, Daniel; Kapur, Navin K.
Afiliación
  • Zweck E; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA; Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
  • Kanwar M; Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
  • Li S; University of Washington Medical Center, Seattle, Washington, USA.
  • Sinha SS; Inova Heart and Vascular Institute, Inova Fairfax Campus, Falls Church, Virginia, USA.
  • Garan AR; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Hernandez-Montfort J; Baylor Scott and White Health, Advanced Heart Failure Program Clinic, Temple, Texas, USA.
  • Zhang Y; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Li B; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Baca P; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Dieng F; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Harwani NM; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
  • Abraham J; Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Research Network, Portland, Oregon, USA.
  • Hickey G; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Nathan S; University of Chicago, Chicago, Illinois, USA.
  • Wencker D; Baylor Scott and White Advanced Heart Failure Clinic, Dallas, Texas, USA.
  • Hall S; Baylor Scott and White Advanced Heart Failure Clinic, Dallas, Texas, USA.
  • Schwartzman A; Maine Medical Center, Portland, Maine, USA.
  • Khalife W; University of Texas Medical Branch, Galveston, Texas, USA.
  • Mahr C; University of Washington Medical Center, Seattle, Washington, USA.
  • Kim JH; Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
  • Vorovich E; Northwestern Medicine, Chicago, Illinois, USA.
  • Whitehead EH; Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Blumer V; Duke University Medical Center, Durham, North Carolina, USA.
  • Westenfeld R; Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
  • Burkhoff D; Cardiovascular Research Foundation, New York, New York, USA.
  • Kapur NK; The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA. Electronic address: Nkapur@tuftsmedicalcenter.org.
JACC Heart Fail ; 11(10): 1304-1315, 2023 10.
Article en En | MEDLINE | ID: mdl-37354148
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 (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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Cardiogénico / Insuficiencia Cardíaca Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: JACC Heart Fail Año: 2023 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Cardiogénico / Insuficiencia Cardíaca Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: JACC Heart Fail Año: 2023 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos