Cardiogenic shock is not a single entity: therapeutic implications.

Area of Science:

• Cardiology
• Critical Care Medicine
• Translational Research

Background:

• Cardiogenic shock (CS) is a critical condition with high mortality, despite advances in cardiovascular care.
• Early recognition and tailored therapeutic strategies are crucial for improving patient outcomes.
• The heterogeneity of CS necessitates advanced phenotyping approaches.

Purpose of the Study:

• To explore the role of phenotyping in understanding and managing cardiogenic shock.
• To highlight the importance of accurate risk stratification and personalized treatment strategies.
• To review current approaches in CS management, including pharmacological and mechanical support.

Main Methods:

• Clinical assessment including "cold and dry," "cold and congested," "warm and dry," and "warm and congested" presentations.
• Aetiological classification encompassing ischemic, de novo heart failure, chronic heart failure decompensation, secondary, and mixed causes.
• Application of advanced phenotyping strategies, including machine learning, and the Society for Cardiovascular Angiography and Interventions classification for severity stratification.

Main Results:

• Mixed shock, combining pump failure and vasodilation, is linked to increased mortality and rapid deterioration.
• Advanced phenotyping identifies distinct CS subgroups with unique prognostic and therapeutic needs.
• The Society for Cardiovascular Angiography and Interventions classification offers a framework for severity assessment and monitoring.

Conclusions:

• Accurate phenotyping is essential for dynamic risk assessment in cardiogenic shock.
• Personalized therapeutic strategies, integrating medical management and mechanical support, are key to improving outcomes.
• Optimizing cardiogenic shock care requires a multi-dimensional approach to patient assessment and treatment.