Cardiogenic shock: Who benefits from heart replacement therapy?

Area of Science:

• Cardiology
• Critical Care Medicine
• Transplantation

Background:

• Characteristics of patients needing heart replacement therapy (HRT) for cardiogenic shock (CS) are not well-defined.
• This study aims to describe the clinical profile of CS patients undergoing HRT.

Purpose of the Study:

• To characterize the clinical profile of cardiogenic shock patients undergoing heart replacement therapy.
• To determine the rates of in-hospital HRT and HRT between discharge and 1-year follow-up in CS patients.

Main Methods:

• Prospective registry (FRENSHOCK) of 772 CS patients across 49 centers.
• HRT included heart transplantation (HTx) and ventricular assist devices (VADs).
• Primary endpoint: in-hospital HRT rate; Secondary endpoint: HRT rate from discharge to 1-year follow-up.

Main Results:

• 6.3% of patients received in-hospital HRT (34 HTx, 15 VADs); 3.8% received HRT between discharge and 1-year follow-up.
• Independent factors for in-hospital HRT included prior ICD, right heart failure signs, elevated bilirubin, dobutamine/levosimendan use, and acute mechanical circulatory support (aMCS).
• Ventricular arrhythmia and aMCS were associated with HRT between discharge and 1-year follow-up.

Conclusions:

• Over 10% of unselected CS patients received HRT (in-hospital or by 1-year follow-up).
• In-hospital mortality rates were comparable between HRT and non-HRT CS patients.
• Further studies are required to optimize HRT selection criteria in CS.