Phenotyping and biomarkers in cardiogenic shock

Cardiogenic shock (CS) remains associated with high mortality despite advances in revascularization, pharmacological therapies and mechanical circulatory support. Traditional staging systems primarily reflect clinical severity but fail to capture the marked biological heterogeneity underlying CS. This review is timely as emerging biomarker-driven approaches offer new opportunities to better characterize this heterogeneity and move toward precision medicine.

CS reflects dysregulation across multiple biological pathways beyond impaired cardiac output. Biomarkers capture key domains including myocardial injury, tissue hypoperfusion, inflammation, endothelial dysfunction, organ injury, and renin-angiotensin-aldosterone system dysfunction. Recent multimarker and omics-based studies, combined with machine learning, have identified reproducible biological subphenotypes with distinct clinical trajectories, prognoses, and potential treatment responsiveness.

Biologically informed phenotyping represents a paradigm shift in CS, enabling improved risk stratification and offering a framework for future enriched clinical trial design and targeted therapies. Integrating biomarker profiles with clinical assessment may allow identification of patients most likely to benefit from specific interventions. Future research should focus on validating subphenotype-guided strategies and translating these insights into personalized management approaches at the bedside.