Background:Cardiogenic shock occurring in the setting of advanced heart failure (HF-CS) is increasingly common. However, recent studies have focused almost exclusively on acute myocardial infarction-related CS. We sought to define clinical, hemodynamic, metabolic, and treatment parameters associated with clinical outcomes among patients with HF-CS, using data from the Cardiogenic Shock Working Group registry.Methods:Patients with HF-CS were identified from the multicenter Cardiogenic Shock Working Group registry and divided into 3 outcome categories assessed at hospital discharge: mortality, heart replacement therapy (HRT: durable ventricular assist device or orthotopic heart transplant), or native heart survival. Clinical characteristics, hemodynamic, laboratory parameters, drug therapies, acute mechanical circulatory support device (AMCS) utilization, and Society of Cardiovascular Angiography and Intervention stages were compared across the 3 outcome cohorts.Results:Of the 712 patients with HF-CS identified, 180 (25.3%) died during their index admission, 277 (38.9%) underwent HRT (durable ventricular assist device or orthotopic heart transplant), and 255 (35.8%) experienced native heart survival without HRT. Patients who died had the highest right atrial pressure and heart rate and the lowest mean arterial pressure of the 3 outcome groups (P<0.01 for all). Biventricular and isolated left ventricular congestion were common among patients who died or underwent HRT, respectively. Lactate, blood urea nitrogen, serum creatinine, and aspartate aminotransferase were highest in patients with HF-CS experiencing in-hospital death. Intraaortic balloon pump was the most commonly used AMCS device in the overall cohort and among patients receiving HRT. Patients receiving >1 AMCS device had the highest in-hospital mortality rate irrespective of the number of vasoactive drugs used. Mortality increased with deteriorating Society of Cardiovascular Angiography and Intervention stages (stage B: 0%, stage C: 10.7%, stage D: 29.4%, stage E: 54.5%, 1-way ANOVA=<0.001).Conclusions:Patients with HF-CS experiencing in-hospital mortality had a high prevalence of biventricular congestion and markers of end-organ hypoperfusion. Substantial heterogeneity exists with use of AMCS in HF-CS with intraaortic balloon pump being the most common device used and high rates of in-hospital mortality after exposure to >1 AMCS device.

中文翻译：

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与心力衰竭相关心源性休克中使用急性机械循环支持相关的临床结果

背景：在晚期心力衰竭 (HF-CS) 中发生的心源性休克越来越常见。然而，最近的研究几乎完全集中在急性心肌梗死相关的 CS。我们试图使用来自心源性休克工作组注册表的数据来定义与 HF-CS 患者临床结果相关的临床、血液动力学、代谢和治疗参数。方法：HF-CS 患者来自多中心心源性休克工作组登记并分为出院时评估的 3 个结果类别：死亡率、心脏替代疗法（HRT：耐用心室辅助装置或原位心脏移植）或自体心脏存活率。临床特征、血流动力学、实验室参数、药物治疗、在 3 个结果队列中比较了急性机械循环支持装置 (AMCS) 的使用、心血管血管造影学会和干预分期。结果：在确定的 712 名 HF-CS 患者中，180 名 (25.3%) 在入院期间死亡，277 名(38.9%) 接受了 HRT（耐用心室辅助装置或原位心脏移植），255 名 (35.8%) 在没有 HRT 的情况下经历了自体心脏存活。死亡患者的右心房压和心率最高，平均动脉压最低（3个结局组）。9%) 接受了 HRT（耐用心室辅助装置或原位心脏移植），255 (35.8%) 名在没有 HRT 的情况下经历了自体心脏存活。死亡患者的右心房压和心率最高，平均动脉压最低（3个结局组）。9%) 接受了 HRT（耐用心室辅助装置或原位心脏移植），255 (35.8%) 名在没有 HRT 的情况下经历了自体心脏存活。死亡患者的右心房压和心率最高，平均动脉压最低（3个结局组）。磷< 0.01 所有）。双心室和孤立的左心室充血分别在死亡或接受 HRT 的患者中很常见。发生院内死亡的 HF-CS 患者的乳酸、血尿素氮、血清肌酐和天冬氨酸转氨酶最高。主动脉内球囊泵是整个队列和接受 HRT 的患者中最常用的 AMCS 装置。无论使用的血管活性药物的数量如何，接受超过 1 个 AMCS 装置的患者的院内死亡率最高。死亡率随着心血管血管造影和介入分期的恶化而增加（B 期：0%，C 期：10.7%，D 期：29.4%，E 期：54.5%，单向方差分析=<0.001）。结论：经历院内死亡的 HF-CS 患者双心室充血和终末器官低灌注标志物的发生率很高。在 HF-CS 中使用 AMCS 存在很大的异质性，主动脉内球囊泵是最常用的设备，并且在暴露于 >1 AMCS 设备后院内死亡率很高。