Cardiogenic shock revisited: From hemodynamic-centric to multimodal precision care

Area of Science:

• Cardiology
• Critical Care Medicine
• Translational Research

Background:

• Cardiogenic shock (CS) presents a significant clinical challenge with high short-term mortality despite advancements in supportive therapies.
• Current diagnostic and therapeutic strategies for CS are primarily hemodynamics-focused, limiting improvements in patient outcomes.
• Emerging evidence highlights the critical roles of inflammation, microcirculatory dysfunction, endothelial injury, and metabolic derangements in CS progression.

Purpose of the Study:

• To re-evaluate the conceptual evolution of cardiogenic shock.
• To examine the limitations of hemodynamic-centric approaches in diagnosing and treating CS.
• To advocate for a paradigm shift towards multimodal precision care for cardiogenic shock.

Main Methods:

• Review of historical and contemporary definitions and staging systems for CS.
• Analysis of current evidence implicating inflammatory and microcirculatory factors in CS.
• Exploration of novel diagnostic modalities including bedside microcirculation assessment, omics, advanced echocardiography, and AI.

Main Results:

• Hemodynamic-centric strategies have not significantly improved CS outcomes.
• Inflammatory activation, microcirculatory dysfunction, and metabolic derangements are key drivers of organ failure in CS.
• Multimodal diagnostic approaches offer potential for earlier recognition and precise classification of CS.

Conclusions:

• Cardiogenic shock should be viewed as a dynamic, multisystem disorder rather than solely a hemodynamic issue.
• A shift towards multimodal precision care, integrating various diagnostic tools, is crucial for improving CS management.
• Future clinical trials and management strategies must adopt a more comprehensive, systems-based approach to cardiogenic shock.