Advances in the Staging and Phenotyping of Cardiogenic Shock
Jacob C. Jentzer, Corbin Rayfield, Sabri Soussi, David D. Berg, Jason Kennedy, Shashank S. Sinha, David A. Baran, Emily Brant, Alexandre Mebazaa, Filio Billia, Navin K. Kapur, Timothy D. Henry, Patrick R. Lawler
Abstract
Cardiogenic shock (CS) is a heterogeneous syndrome reflecting a broad spectrum of shock severity, diverse etiologies, variable cardiac function, different hemodynamic trajectories, and concomitant organ dysfunction. These factors influence the clinical presentation, management, response to therapy, and outcomes of CS patients, necessitating a tailored approach to care. To better understand the variability inherent to CS populations, recent algorithms for staging the severity of CS have been described and validated. This paper is part 1 of a 2-part state-of-the-art review. In this first article, we consider the context for clinical staging and stratification in CS with a focus on established severity staging systems for CS and their use for risk stratification and clinical care. We describe the use of staging for predicting outcomes in populations with or at risk for CS, including risk modifiers that provide more nuanced risk stratification, and highlight how these approaches may allow individualized care.