Cardiogenic shock: Who benefits from heart replacement therapy?

The characteristics of patients requiring heart replacement therapy (HRT) in cardiogenic shock (CS) are poorly described. This study aims to characterize the clinical profile of CS patients undergoing HRT.

FRENSHOCK is a prospective registry including 772 CS patients from 49 centres. HRT included heart transplantation (HTx) and ventricular assist devices (VADs). The primary endpoint was the rate of in-hospital HRT. The secondary endpoint was the rate of HRT performed between discharge and 1-year follow-up.

Among 772 patients, 49 (6.3 %) underwent in-hospital HRT (11 LVADs, 4 BiVADs, 34 HTx), including 10 (20.4 %) who died before discharge. Multivariate analysis identified several independent factors for in-hospital HRT: Prior ICD (aOR 1.18 [1.09-1.27], p < 0.01), signs/symptoms of right heart failure (aOR 1.06 [1.01-1.12] p = 0.02), bilirubin level ≥ 18.9 mg/L (aOR 1.06 [1.01-1.12], p = 0.02), use of dobutamine (aOR 1.11 [1.01-1.23], p = 0.049) or levosimendan (aOR 1.10 [1.01-1.21], p = 0.04), and acute mechanical circulatory support (aMCS) (aOR 1.16 [1.08-1.25], p < 0.01). Subsequently, 29 patients (3.8 % of the cohort, 5.6 % of in-hospital survivors) underwent HRT between discharge and 1-year follow-up. Ventricular arrhythmia (aOR 1.08 [1.01-1.17], p = 0.04) and aMCS (aOR 1.23 [1.12-1.35], p < 0.01) were associated with HRT between discharge and the 1-year follow-up.

In this large cohort of unselected CS patients, HRT was performed in more than 10 % of cases (6.3 % in-hospital and 3.8 % between discharge and 1-year follow-up), with a comparable in-hospital mortality rate to non-HRT patients. Further studies are needed to optimize the selection criteria for HRT in CS patients.