Related Experiment Video
Updated: Jul 24, 2025
Real-time Pressure-volume Analysis of Acute Myocardial Infarction in Mice
Published on: July 2, 2018
Phenotyping cardiogenic shock that showed different clinical outcomes and responses to vasopressor use: a latent
Yue Yu1, Jin Rao1, Qiumeng Xu2
1Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
Insights
This study identified three distinct cardiogenic shock (CS) phenotypes in patients with acute myocardial infarction. Different CS profiles exhibited varying mortality risks and responses to vasopressor therapy, highlighting the need for personalized treatment strategies.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Medical Informatics
Background:
- Cardiogenic shock (CS) is recognized for its heterogeneity in severity and treatment response.
- Understanding CS phenotypes is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify distinct cardiogenic shock (CS) phenotypes.
- To investigate the association between CS phenotypes and patient outcomes.
- To analyze the differential response of CS phenotypes to vasopressor therapy.
Main Methods:
- Latent profile analysis (LPA) was employed to identify CS phenotypes.
- Multivariable logistic regression (LR) was used to assess the association between vasopressor use and mortality.
- Data were sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, including 630 patients with CS post-acute myocardial infarction (AMI).
Main Results:
- Three CS phenotypes were identified: Profile 1 (baseline), Profile 2 (older, comorbid, worse renal function), and Profile 3 (SIRS-related, acid-base disturbance).
- Profile 3 exhibited the highest in-hospital mortality (45.9%), followed by Profile 2 (43.3%) and Profile 1 (16.6%).
- Profiles 2 and 3 were independently associated with increased in-hospital mortality risk (OR 3.95 and 3.90, respectively). Vasopressor use improved mortality risk in Profiles 2 and 3, but not in Profile 1.
Conclusions:
- Distinct CS phenotypes exist, characterized by different clinical profiles and prognoses.
- Phenotype is an independent predictor of outcomes in CS patients.
- Tailored vasopressor strategies based on CS phenotype may improve patient survival.
Background:
Cardiogenic shock (CS) is increasingly recognized as heterogeneous in its severity and response to therapies. This study aimed to identify CS phenotypes and their responses to the use of vasopressors.
Method:
The current study included patients with CS complicating acute myocardial infarction (AMI) at the time of admission from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Laboratory and clinical variables were collected and used to conduct latent profile (LPA) analysis. Furthermore, we used a multivariable logistic regression (LR) model to explore the independent association between the use of vasopressors and endpoints.
Result:
A total of 630 eligible patients with CS after AMI were enrolled in the study. The LPA identified three profiles of CS: profile 1 (n = 259, 37.5%) was considered as the baseline group; profile 2 (n = 261, 37.8%) was characterized by advanced age, more comorbidities, and worse renal function; and profile 3 (n = 170, 24.6%) was characterized by systemic inflammatory response syndrome (SIRS)-related indexes and acid-base balance disturbance. Profile 3 showed the highest all-cause in-hospital mortality rate (45.9%), followed by profile 2 (43.3%), and profile 1 (16.6%). The LR analyses showed that the phenotype of CS was an independent prognostic factor for outcomes, and profiles 2 and 3 were significantly associated with a higher risk of in-hospital mortality (profile 2: odds ratio [OR] 3.95, 95% confidence interval [CI] 2.61-5.97, p < 0.001; profile 3: OR 3.90, 95%CI 2.48-6.13, p < 0.001) compared with profile 1. Vasopressor use was associated with an improved risk of in-hospital mortality for profile 2 (OR: 2.03, 95% CI: 1.15-3.60, p = 0.015) and profile 3 (OR: 2.91, 95% CI: 1.02-8.32, p = 0.047), respectively. The results of vasopressor use showed no significance for profile 1.
Conclusion:
Three phenotypes of CS were identified, which showed different outcomes and responses to vasopressor use.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:30Acute Coronary Syndrome III: Diagnostic Studies