Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jul;27(4):1105-1117.
doi: 10.1007/s10741-021-10140-7. Epub 2021 Jul 14.

Risk stratification in cardiogenic shock: a focus on the available evidence

C Sciaccaluga  1 , G E Mandoli  2 , N Ghionzoli  2 , F Anselmi  2 , C Sorini Dini  2 , F Righini  2 , F Cesareo  2 , F D'Ascenzi  2 , M Focardi  2 , S Valente  2 , M Cameli  2
Affiliations
Review

Risk stratification in cardiogenic shock: a focus on the available evidence

C Sciaccaluga et al. Heart Fail Rev. 2022 Jul.

Abstract

Cardiogenic shock is a clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia. It represents a complex life-threatening condition, characterized by a high mortality rate, that requires urgent diagnostic assessment as well as treatment; therefore, it is of paramount important to advocate for a thorough risk stratification. In fact, the early identification of patients that could benefit the most from more aggressive and invasive approaches could facilitate a more efficient resource allocation. This review attempts to critically analyse the current evidence on prognosis in cardiogenic shock, focusing in particular on clinical, laboratoristic and echocardiographic prognostic parameters. Furthermore, it focuses also on the available prognostic scores, highlighting the strengths and the possible pitfalls. Finally, it provides insights into future direction that could be followed in order to ameliorate risk stratification in this delicate subset of patients.

Keywords: Biomarkers; Cardiogenic shock; Echocardiography; Prognostic score; Risk stratification.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cardiogenic shock phenotypes
Fig. 2
Fig. 2
Cardiogenic shock epidemiology
Fig. 3
Fig. 3
Readapted SCAI classification [6]
Fig. 4
Fig. 4
Echocardiographic assessment of patients admitted for cardiogenic shock. This picture shows different echocardiographic scenarios that can be found in patients admitted to intensive cardiac care unit for cardiogenic shock. The two images at the top show a severely dilated and impaired left ventricle with decreased wall thickness compatible with dilated cardiomyopathy, in presence of left ventricular thrombosis. The picture at the bottom left shows a left ventricular pseudoaneurism in a patient with a recent ST-elevation myocardial infarction, with flow passage demonstrated by Color Doppler. The picture at the bottom right shows a finding suspicious for left ventricular aneurism or pseudoaneurism, in presence of extensive thrombosis
Fig. 5
Fig. 5
Echocardiographic assessment of possible contraindications to mechanical circulatory support. The picture on the left shows the presence of intracardiac thrombosis, localized at the apex of left ventricle. On the other hand, the picture on the right shows a case of significant aortic regurgitation with an eccentric jet, visualized in apical 3-chamber view. Both of these patients presented two possible contraindications to mechanical circulatory support placement
Fig. 6
Fig. 6
Echocardiographic assessment during mechanical circulatory support with Impella. This picture shows the echocardiographic assessment of cannula position during Impella support in two different patients. The distance from the inlet of the cannula and the aortic root, which should be around 35 mm in parasternal long axis view (top pictures), should be routinely measured in order to monitor cannula position and assess possible cannula dislocation. The picture at the bottom shows the outlet of the motor in the ascending aorta, visualized with the aid of Color Doppler
See this image and copyright information in PMC

References

    1. Aissaoui N, Puymirat E, Delmas C, Ortuno S, Durand E, Bataille V, Drouet E, Bonello L, Bonnefoy-Cudraz E, Lesmeles G, Guerot E, Schiele F, Simon T, Danchin N (2020) Trends in cardiogenic shock complicating acute myocardial infarction. Eur J Heart Fail - PubMed
    1. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG (2017) American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary Management of Cardiogenic Shock: a scientific statement from the American Heart Association. Circulation 136(16):e232-e268 - PubMed
    1. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. New Engl J Med. 2012;367:1287–1296. doi: 10.1056/NEJMoa1208410. - DOI - PubMed
    1. Chakaramakkil MJ, Sivathasan C. ECMO and Short-term Support for Cardiogenic Shock in Heart Failure. Curr Cardiol Rep. 2018;20:87. doi: 10.1007/s11886-018-1041-4. - DOI - PubMed
    1. Furer A, Wessler J, Burkhoff D. Hemodynamics of cardiogenic shock. Interv Cardiol Clin. 2017;6(3):359–371. - PubMed

Publication types