Circulation: Heart Failure最新文献

{"title":"Proteomics Profiling Reveals Molecular Subtypes of Transthyretin Cardiac Amyloidosis.","authors":"Itsuki Osawa, Sergio L Teruya, Dimitrios Bampatsias, Alfonsina Mirabal, Mathew S Maurer, Yuichi J Shimada","doi":"10.1161/CIRCHEARTFAILURE.125.012449","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012449","url":null,"abstract":"<p><strong>Background: </strong>Transthyretin cardiac amyloidosis (ATTR-CA) may involve heterogeneity in biological mechanisms (ie, molecular subtypes). Molecular subtypes potentially lead to differences in prognosis and treatment response to tafamidis-the first disease-modifying therapy for ATTR-CA. We aimed to derive molecular subtypes of ATTR-CA through comprehensive plasma proteomics profiling and to examine their associations with prognosis and estimated treatment effect of tafamidis.</p><p><strong>Methods: </strong>We applied unsupervised machine learning to comprehensive plasma proteomics profiling of 7289 proteins to identify molecular subtypes in our prospective cohort of patients with ATTR-CA enrolled at Columbia University. We compared all-cause mortality risk and estimated the treatment effect of tafamidis among the identified molecular subtypes, adjusting for age, sex, TTR genotype, and concomitant medication use. We also performed pathway analysis comparing the worst prognosis subtype with the other subtypes combined.</p><p><strong>Results: </strong>Among 142 patients eligible for analysis, 96 patients received tafamidis treatment. We identified 3 molecular subtypes (subtype A: n=49, subtype B: n=38, and subtype C: n=55) with different survival risks during a median follow-up of 5.2 years (log-rank <i>P</i>=0.035), without significant differences in traditional clinical stages. Mortality risk was highest in subtype A, followed by B and then C (eg, adjusted hazard ratio of subtype A versus C [95% CI], 1.95 [1.03-3.66]; <i>P</i>=0.04). The largest treatment effect of tafamidis was observed in subtype A compared with no tafamidis use within the same subtype (adjusted hazard ratio for mortality, 0.24 [0.10-0.55]), indicating heterogeneous treatment effects of tafamidis (<i>P</i> for interaction=0.001). Subtype A had dysregulation of Ras/MAPK (mitogen-activated protein kinase) pathways, pathways implicated in ATTR-CA pathogenesis, and metabolic/inflammatory pathways.</p><p><strong>Conclusions: </strong>Our prospective cohort study using comprehensive plasma proteomics profiling not only uncovered molecular ATTR-CA subtypes but also identified pathogenetic mechanisms associated with differential prognosis and estimated the treatment effect of tafamidis.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012449"},"PeriodicalIF":8.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Outcomes of Cardiac Sarcoidosis: Insights From the Nationwide MYSTICS Registry.","authors":"Chisato Izumi, Yusuke Yoshikawa, Issei Komuro, Ken-Ichi Hirata, Koh Ono, Yasushi Sakata, Fumio Terasaki, Takafumi Suda, Hidekazu Tanaka, Toshihiro Tamura, Takeshi Kitai, Takao Kato, Hiroyuki Takahama, Yoichi Takaya, Mika Mori, Yuichi Baba, Kimi Sato, Shunsuke Ishii, Kengo Kusano, Kunihiro Nishimura","doi":"10.1161/CIRCHEARTFAILURE.126.014184","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014184","url":null,"abstract":"<p><strong>Background: </strong>Cardiac sarcoidosis (CS) may lead to serious outcomes, but large-scale data are lacking because of its rarity, diagnostic uncertainty, and heterogeneous clinical presentations. Actual management and outcomes, including recurrence, are not well understood. This study aimed to clarify the actual management and outcomes of CS from a nationwide large-scale registry.</p><p><strong>Methods: </strong>This multicenter retrospective registry enrolled 2366 consecutive patients with CS. Of these, 1852 patients newly diagnosed between 2012 and 2021 were analyzed. Patients were stratified into 4 groups: definite CS, probable CS, presumed systemic sarcoidosis, and presumed isolated CS based on diagnostic criteria. The primary end point was a composite of all-cause death, heart failure hospitalization, or fatal ventricular arrhythmic event. The secondary end point was recurrence of CS.</p><p><strong>Results: </strong>Cardiac imaging performance rates were high (cardiac magnetic resonance: 64%, ¹⁸F-fluorodeoxyglucose positron emission tomography: 82%), and 974 (53%) patients were diagnosed clinically without histological evidence. During a median 5.1-year follow-up, the primary outcome occurred in 519 (28%, 6.4/100 patient-years) patients, and the 4 groups exhibited different clinical presentations and prognoses; definite CS and presumed isolated CS groups showed a high incidence of the primary end point, fatal ventricular arrhythmic event, hospitalization for heart failure, and cardiovascular death. Most patients (89%) received immunosuppressive therapy, but 291 (18%, 4.1/100 patient-years) patients developed recurrence during steroid tapering, with a 5-year recurrence rate of 17.0%. Recurrence was associated with subsequent primary end point (hazard ratio, 1.38 [95% CI, 1.00-1.89]; <i>P</i>=0.048).</p><p><strong>Conclusions: </strong>This large-scale multicenter registry showed that clinical presentation and prognosis differ depending on the presence or absence of extracardiac lesions and histological evidence; therefore, it is necessary to recognize the characteristics of each phenotype in managing CS.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014184"},"PeriodicalIF":8.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care Models for the Genetic Evaluation of Dilated Cardiomyopathy at Sites of the DCM Consortium.","authors":"Elizabeth Jordan, Tia Moscarello, Hibatallah Khafagy, Patricia K Parker, Phoenix Grover, Simone Weinmann, Joseph Liu, Alberta Nomo, Naomi Barker, Emily E Brown, Akos Berthold, Jessica Chowns, Susan Christian, Amy Ekwurtzel, Judy Fan, Monisha Kisling, Daria Ma, Erin M Miller, Jessica Sweeney, Brian Reys, Nancy Robles, Lisa Von Wald, Wendy Flowers, Gregory L Hershberger, Krishna G Abraham, Michael A Burke, Jamie Diamond, Mark H Drazner, Gregory A Ewald, Stephen S Gottlieb, Garrie Haas, Mark Hofmeyer, Gordon S Huggins, Javier Jimenez, Daniel P Judge, Stuart Katz, Masataka Kawana, Evan P Kransdorf, Cindy M Martin, Elina Minami, Anjali Owens, Palak Shah, Chetan Shenoy, Supriya Shore, Frank Smart, Douglas Stoller, Jose Tallaj, W H Wilson Tang, Jessica Wang, Jane Wilcox, Ray E Hershberger","doi":"10.1161/CIRCHEARTFAILURE.126.014544","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014544","url":null,"abstract":"<p><strong>Background: </strong>Clinical genetic evaluation for patients with dilated cardiomyopathy (DCM) is minimally implemented, and models of care are not well defined. To understand current genetic care for DCM, a systematic needs assessment was conducted.</p><p><strong>Methods: </strong>Principal investigators of the DCM Consortium convened at the Summer Scientific Symposium in July 2025. An electronic needs assessment was conducted among the 24 principal investigators in advance to define current care models by evaluating which genetic evaluation components recommended by the Heart Failure Society of America were conducted, by whom, and the time required for each component. Descriptive statistics were generated to characterize model features. Focus group discussions explored barriers and facilitators to implementing genetic services.</p><p><strong>Results: </strong>Four care models emerged from the principal investigator responses: model 1: Traditional-Synchronous (25%, n=6, requiring the most time per patient); model 2: Traditional-Asynchronous (33%, n=8); model 3: Externally Sourced (17%, n=4); and model 4: Physician/Advanced Practice Provider Conducted (25%, n=6, requiring the least time per patient). All models used genetic testing, whereas other components were implemented variably or not at all. Models 1 (15.7<i>±</i>4.1) and 2 (15.4<i>±</i>3.0) were rated more acceptable than model 4 (9.8<i>±</i>2.9; model 1 versus model 4; <i>P</i>=0.027; model 2 versus model 4; <i>P</i>=0.023). Notably, 88% of principal investigators used genetic information for treatment decisions, including implantable cardioverter defibrillator placement (83%; n=20) and cardiac transplantation (63%; n=15). Major facilitator themes from focus group discussions included having a genetic counselor as part of the heart failure team and developing authoritative standards directing provision of DCM genetic services. Barrier themes included operational challenges, limited personnel, clinician under-recognition, need for new service delivery models, and billing/reimbursement.</p><p><strong>Conclusions: </strong>DCM genetic care models and components were highly variable across the 24 sites of the DCM Consortium, although all sites discussed similar factors that enable or hinder the implementation of genetic services for DCM. Understanding the basis of practice model variability may provide insight to yield more scalable care approaches.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014544"},"PeriodicalIF":8.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Strain Combinations for Prognostic Prediction in Pulmonary Arterial Hypertension.","authors":"Jiajun Guo, Shuang Leng, Juan He, Lidan Yin, Chen Chen, Xuhan Liu, Ji Zhao, Bi Wen, Shoufang Pu, Ke Wan, Jie Wang, Yuanwei Xu, Yangjie Li, Yuchi Han, Liang Zhong, Yucheng Chen","doi":"10.1161/CIRCHEARTFAILURE.126.014519","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014519","url":null,"abstract":"<p><strong>Background: </strong>Strain parameters are sensitive indicators of myocardial performance, but the optimal combination for prognostic prediction in pulmonary arterial hypertension remains unclear.</p><p><strong>Methods: </strong>Patients diagnosed with pulmonary arterial hypertension between June 2013 and June 2024 were prospectively recruited. Strain parameters, including left ventricular global longitudinal strain, right ventricular GLS, right ventricular free-wall longitudinal strain, and right atrial phasic strain, were analyzed. Feature selection used elastic net Cox regression and stepwise Cox regression with the Akaike information criterion. Survival analyses were performed for all-cause mortality and a composite end point (mortality and heart failure rehospitalization).</p><p><strong>Results: </strong>A total of 269 patients with pulmonary arterial hypertension (mean age, 42±15 years) were included. During a median follow-up of 39.3 months, 68 patients reached the primary end point, and 91 reached the secondary end point. The combination of left ventricular global longitudinal strain and right atrial reservoir strain had the strongest prognostic value. Both left ventricular global longitudinal strain (hazard ratio, 1.46, per 5% increase [95% CI, 1.07-2.00]; <i>P</i>=0.02) and right atrial reservoir strain (hazard ratio, 0.77, per 5% increase [95% CI, 0.62-0.95]; <i>P</i>=0.02) remained independent predictors of all-cause mortality. Their combination outperformed conventional cardiac magnetic resonance and clinical models, as evidenced by higher C-index values (all <i>P</i>≤0.05), and stratified patients into low-, intermediate-, and high-risk groups with distinct 1-year mortality rates (2.8%, 6.2%, 21.0%, respectively; <i>P</i><0.001). Landmark analysis confirmed their long-term prognostic relevance.</p><p><strong>Conclusions: </strong>The combined assessment of left ventricular global longitudinal strain and right atrial reservoir strain yields the strongest prognostic utility among the strain parameters in pulmonary arterial hypertension, significantly improves risk stratification beyond several established cardiac magnetic resonance and clinical predictors, and holds promise as a practical tool for guiding management strategies.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014519"},"PeriodicalIF":8.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Get With The Guidelines-Heart Failure Hospital Participation and Its Association With Guideline-Directed Medical Therapy and Outcomes.","authors":"Aradhana Verma, Gregg C Fonarow, Paul Heidenreich, Larry A Allen, Andrew P Ambrosy, Shun Kohsaka, Anubodh S Varshney, Nicholas Brownell, Jun Fan, Alexander T Sandhu","doi":"10.1161/CIRCHEARTFAILURE.126.014414","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014414","url":null,"abstract":"<p><strong>Background: </strong>Despite strong evidence, adoption of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction remains suboptimal. The Get With The Guidelines-Heart Failure (GWTG-HF) program was designed to close gaps in care. We evaluated whether hospital participation in GWTG-HF was associated with greater GDMT intensity and improved outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis (2013-2021) of Medicare beneficiaries with part A and part D hospitalized with heart failure with reduced ejection fraction. Using a multiple baseline time series design, we compared changes in GDMT and outcomes before and after GWTG-HF enrollment with hospitals that never participated. Coprimary outcomes were a 90-day postdischarge GDMT score under a parallel and nonparallel slopes model. Secondary outcomes included class-specific medication fills, achievement of ≥50% target doses, and 30-day, 90-day, and 1-year all-cause and HF readmission and mortality. Mortality and first HF readmission were also evaluated using Cox proportional hazards models. We adjusted for baseline hospital performance, patient characteristics, and temporal trends.</p><p><strong>Results: </strong>Among 1274 863 Medicare beneficiaries hospitalized for heart failure with reduced ejection fraction, 53.5% were treated at hospitals that never participated in GWTG-HF and 9.6% at GWTG-HF hospitals. Unadjusted median GDMT scores increased from 3.0 in both groups to 4.0 in nonparticipating hospitals and 4.5 in GWTG-HF hospitals at 90 days (<i>P</i><0.001). Hospital enrollment was associated with a higher 90-day GDMT score (+0.15 points [95% CI, 0.12-0.20]; <i>P</i><0.001) and greater use of β-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists but not angiotensin receptor-neprilysin inhibitors. GWTG-HF participation was associated with lower all-cause mortality at 30 days (odds ratio, 0.95 [95% CI, 0.92-0.98]) and 1 year (0.97 [95% CI, 0.949-0.995]; both <i>P</i><0.05). Mortality differences were attenuated and no longer significant in the nonparallel slopes model.</p><p><strong>Conclusions: </strong>Hospital participation in GWTG-HF was associated with modest but significant improvements in postdischarge GDMT intensity, supporting the value of quality improvement initiatives to address persistent treatment gaps in heart failure with reduced ejection fraction.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014414"},"PeriodicalIF":8.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Node-Based Framework for Regionalized Cardiogenic Shock Systems of Care: Evidence, Design, and Future Directions.","authors":"Marc D Samsky, Bernard S Kadosh, Shashank S Sinha, Jacqueline Tamis-Holland, Shaina Costello, Esther E Vorovich, Sunil V Rao","doi":"10.1161/CIRCHEARTFAILURE.126.014188","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014188","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a cardiovascular emergency with short-term mortality ranging from 30% to 40% despite an expanding therapeutic armamentarium. Structured systems of care have transformed outcomes in ST-segment-elevation myocardial infarction, stroke, and out-of-hospital cardiac arrest through tiered hospital designations, standardized protocols, and regionalized networks, yet no analogous framework exists for CS. CS differs from these conditions in ways that complicate direct application of existing models: the appropriate intervention varies by cause, hemodynamic phenotype, and shock severity; the therapeutic trajectory is iterative and uncertain rather than binary and time-fixed; prehospital identification is rarely feasible; and the exit strategy, encompassing myocardial recovery, durable mechanical support, transplantation, or palliation, has no parallel in other cardiovascular emergencies. Observational data suggest an association between structured multidisciplinary care, regionalized networks, and more consistent care delivery though causal relationships remain unestablished, and no standardized national framework for CS center designation yet exists. We propose that CS systems of care should be organized around a node-based model in which each hospital tier has a defined role, transfer is guided by physiological trajectory and exit strategy candidacy rather than geography, and system performance is evaluated by metrics of timing, outcomes, and equity. The American Heart Association Cardiogenic Shock Registry, designed to enroll consecutive patients across all etiologies and severity levels, represents the natural infrastructure around which this framework can be constructed. Realizing this vision will require dedicated registries, implementation research, and a definition of success that extends beyond in-hospital survival to encompass recovery, function, and equitable access to care.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014188"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulatory Support Escalation in Cardiogenic Shock: Outcomes and Predictors of Successful Escalation From an International, Multi-Center Cardiac Intensive Care Registry.","authors":"Luca Baldetti, Guglielmo Gallone, Jorge A Ortega-Hernández, Giulio Cacioli, Mariagiulia Festi, Francesca Pirone, Federica Curro Dossi, Pier Paolo Bocchino, Filippo Angelini, Lorenzo Brignone, Veronica Vitiello, Francesco Maria Perulli, Emilio D'Avino, Héctor González-Pacheco, Francesco Calvo, Stefania Sacchi, Marina Pieri, Antonio Loforte, Silvia Ajello, Simone Frea, Giampaolo Luzi, Alexandra Arias-Mendoza, Jaime Hernández-Montfort, Marco Metra, Gaetano Maria De Ferrari, Anna Mara Scandroglio","doi":"10.1161/CIRCHEARTFAILURE.125.014049","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.014049","url":null,"abstract":"<p><strong>Background: </strong>Circulatory support escalation is often required during cardiogenic shock (CS) treatment. Currently, no large-scale data is available to inform how escalation strategies integrate in contemporary CS management and affect outcomes.</p><p><strong>Methods: </strong>We assessed the frequency, outcomes, and prognostic implications of escalation from a retrospective international registry of patients with CS from 4 cardiac intensive care units. Escalation was defined as any incremental change in the circulatory support strategy after an initial bundle of care was established for at least 4 hours.</p><p><strong>Results: </strong>Among 602 consecutive patients with CS, escalation was required in 30%. Patients were escalated to inotropes/vasopressors (36%), intra-aortic balloon pump (39%), Impella (14%), or venoarterial extracorporeal membrane oxygenation (11%). Escalation was associated with a higher hospital mortality rate (43% versus 21%; <i>P</i><0.001; adjusted odds ratio, 3.42 [95% CI, 2.21-3.35]) and a greater transition to heart replacement therapies (23% versus 5%; <i>P</i><0.001; adjusted odds ratio, 6.01 [95% CI, 3.31-11.27]), when adjusted for age, sex, chronic kidney disease, markers of CS severity on admission, CS cause, and admission source. Escalation was associated with a higher risk of complications, including acute kidney injury, major bleeding, and stroke. These outcomes occurred more frequently with high-profile mechanical circulatory support (Impella, V-A extracorporeal membrane oxygenation). Complications mediated 24% (95% CI, 9%-40%) of the association between escalation and hospital death. Escalated patients were successfully discharged alive in 42%. Age, the Society for Cardiovascular Angiography and Intervention B to C stage at escalation, tricuspid annular plane systolic excursion at escalation, and mean urinary output ≥1 mL/kg per hour in the 6 hours preceding escalation were independently associated with successful escalation when adjusted for sex, chronic kidney disease, and markers of CS severity on admission and at time of escalation.</p><p><strong>Conclusions: </strong>Circulatory support escalation is prevalent in patients treated for CS. Escalation is associated with a higher risk of hospital death, complications, and transition to heart replacement therapy, consistent with the intrinsically higher risk profile and expected trajectory of escalated patients. However, outcomes may differ according to the specific escalation strategy. Resorting to escalation in younger patients, in less severe CS stages, when the right ventricular function and urinary output are still preserved, is associated with a higher chance of subsequent survival.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014049"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Recovery-Focused Framework for the Management of Cardiogenic Shock.","authors":"Christos P Kyriakopoulos, Iosif Taleb, Rana Hamouche, Eleni Tseliou, Stavros G Drakos","doi":"10.1161/CIRCHEARTFAILURE.126.014307","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014307","url":null,"abstract":"<p><p>Cardiogenic shock describes a syndrome of systemic hypoperfusion due to insufficient cardiac output. Therapeutic interventions aim to restore systemic perfusion and oxygen delivery, relieve congestion, and reverse the primary culprit pathologies that precipitate shock. Cardiogenic shock care often emphasizes acute rescue and survival; however, survival does not always equal meaningful recovery. In this review, we propose a recovery-focused framework in which myocardial and end-organ recovery are treated as explicit, measurable targets. Building upon prior frameworks proposed for the management of shock, we organize cardiogenic shock management into four overlapping phases: salvage, optimization, stabilization, and de-escalation. Each phase addresses a distinct clinical question: can the patient be rescued, is perfusion and unloading sufficient to prevent further injury, is meaningful myocardial and end-organ recovery occurring, and is recovery durable enough to withdraw support? We synthesize current strategies and highlight emerging targets and research priorities spanning early identification and triage, integrated macro- and microcirculatory monitoring, phenotype-guided management, targeted metabolic and immunologic therapies, use of mechanical circulatory support as a recovery platform, and structured de-escalation of care.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014307"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SCAI Stage B Cardiogenic Shock: Beginning, Bad, and Broad?","authors":"Vanessa Blumer, Shashank S Sinha","doi":"10.1161/CIRCHEARTFAILURE.126.014192","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014192","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014192"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiogenic Shock Systems of Referral: Right Patient, Right Place, Right Time.","authors":"James W Schurr, Joyce W Wald","doi":"10.1161/CIRCHEARTFAILURE.126.014983","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014983","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014983"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}