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Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype
Journal article   Open access   Peer reviewed

Clinical Course of Patients in Cardiogenic Shock Stratified by Phenotype

Elric Zweck, Manreet Kanwar, Song Li, Shashank S. Sinha, A. Reshad Garan, Jaime Hernandez-Montfort, Yijing Zhang, Borui Li, Paulina Baca, Fatou Dieng, …
JACC. Heart failure, v 11(10), pp 1304-1315
01 Oct 2023
DOI: https://doi.org/10.1016/j.jchf.2023.05.007
PMID: 37354148
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.jchf.2023.05.007View
Published, Version of Record (VoR)Open Access (Publisher-Specific),  Restricted

Abstract

acute heart failure cardiogenic shock mechanical circulatory support outcomes phenotypes SCAI stages Machine Learning
Cardiogenic shock (CS) patients remain at 30% to 60% in-hospital mortality despite therapeutic innovations. Heterogeneity of CS has complicated clinical trial design. Recently, 3 distinct CS phenotypes were identified in the CSWG (Cardiogenic Shock Working Group) registry version 1 (V1) and external cohorts: I, “noncongested;” II, “cardiorenal;” and III, “cardiometabolic” shock. The aim was to confirm the external reproducibility of machine learning–based CS phenotypes and to define their clinical course. The authors included 1,890 all-cause CS patients from the CSWG registry version 2. CS phenotypes were identified using the nearest centroids of the initially reported clusters. Phenotypes were retrospectively identified in 796 patients in version 2. In-hospital mortality rates in phenotypes I, II, III were 23%, 41%, 52%, respectively, comparable to the initially reported 21%, 45%, and 55% in V1. Phenotype-related demographic, hemodynamic, and metabolic features resembled those in V1. In addition, 58.8%, 45.7%, and 51.9% of patients in phenotypes I, II, and III received mechanical circulatory support, respectively (P = 0.013). Receiving mechanical circulatory support was associated with increased mortality in cardiorenal (OR: 1.82 [95% CI: 1.16-2.84]; P = 0.008) but not in noncongested or cardiometabolic CS (OR: 1.26 [95% CI: 0.64-2.47]; P = 0.51 and OR: 1.39 [95% CI: 0.86-2.25]; P = 0.18, respectively). Admission phenotypes II and III and admission Society for Cardiovascular Angiography and Interventions stage E were independently associated with increased mortality in multivariable logistic regression compared to noncongested “stage C” CS (P < 0.001). The findings support the universal applicability of these phenotypes using supervised machine learning. CS phenotypes may inform the design of future clinical trials and enable management algorithms tailored to a specific CS phenotype. [Display omitted]

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Web of Science research areas
Cardiac & Cardiovascular Systems
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