Circulation: Heart Failure最新文献

{"title":"Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).","authors":"David E Hamilton, Jackson L Shriver, Siddharth M Patel, Jeong-Gun Park, Zoe E Michos, Michael R Mathis, Sarah K Adie, Carlos L Alviar, Christopher F Barnett, David D Berg, Courtney E Bennett, Erin A Bohula, Anthony P Carnicelli, Lori B Daniels, Mark W Dodson, Ann Gage, Umesh Gidwani, Michael Goldfarb, Jason N Katz, Scott W Ketcham, Younghoon Kwon, Evan S Leibner, Daniel B Loriaux, Adriana Luk, Paul Marano, P Elliott Miller, Srini V Mukundan, Alexander I Papolos, Barbara A Pisani, Alastair G Proudfoot, Robert O Roswell, Kevin S Shah, Michael A Solomon, Matthew I Tomey, Sean van Diepen, Sammy Zakaria, David A Morrow, Andrea D Thompson","doi":"10.1161/CIRCHEARTFAILURE.125.013778","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013778","url":null,"abstract":"<p><strong>Background: </strong>The paucity of data to guide selection of specific vasoactive agents in patients with cardiogenic shock (CS) may lead to variability in practice patterns. The level of variability and specific factors that are associated with the use of vasoactive medications and inodilators have not been previously described.</p><p><strong>Methods: </strong>The CCCTN (Critical Care Cardiology Trials Network) is an international, multicenter network of cardiac intensive care units (CICUs) coordinated by the Thrombolysis in Myocardial Infarction Study Group. This analysis included CICU admissions for CS from 2019 to 2023. Variation in the use of inodilator treatment (dobutamine/milrinone) was assessed with multivariable mixed-effects logistic modeling.</p><p><strong>Results: </strong>A total of 3282 admissions from 37 CICUs comprised the analysis cohort. The use of vasoactive medications, including inodilator treatment, varied substantially across institutions. Patient-level variables associated with greater use of inodilators included history of heart failure (odds ratio, 1.98 [95% CI, 1.61-2.44]), biventricular failure (1.59 [95% CI, 1.27-2.00]), Society of Cardiovascular Angiography and Interventions stage D (1.34 [95% CI, 1.07-1.68]), valvular disease (1.34 [95% CI, 1.03-1.74]), and male sex (1.23 [95% CI, 1.02-1.49]). Variables associated with less inodilator use included cardiac arrest (0.33 [95% CI, 0.27-0.42]), right ventricular failure (0.50 [95% CI, 0.33-0.73]), Society of Cardiovascular Angiography and Interventions stage E (0.57 [95% CI, 0.41-0.81]), acute myocardial infarction-CS (0.71 [95% CI, 0.56-0.90]), peripheral arterial disease (0.73 [95% CI, 0.54-0.99]), older age (0.77 [95% CI, 0.72-0.83], per 10-year increase), and estimated glomerular filtration rate (0.96 [95% CI, 0.93-0.99], per 10 mL/min per 1.73 m² increase). No individual measurable institution-level factors (eg, transplant center) were associated with variability in inodilator use. In mixed-effects logistic modeling, 45.7% of variation in inodilator use was attributed to patient-level factors and 22.7% to the random effect of individual CICU centers. Similarly, 35.3% of variation in the use of dobutamine versus milrinone was attributed to patient-level factors and 32.6% to the random effect of individual CICU centers.</p><p><strong>Conclusions: </strong>There is significant variation in vasoactive treatment and inodilator use in CS. Variation in inodilator use was associated with patient-level factors and with substantial individual CICU practice variation. Such variability underscores the need for additional high-quality evidence to guide vasoactive treatment strategies in CS.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013778"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834345","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":"Cardiogenic Shock Management: A Framework for Individualized Microaxial Flow Pump Support.","authors":"Charlotte Starling, Jonathan Moreno, Walter Schiffer, Amit Pawale, Muhammad Masood, Kunal Kotkar, Saraschandra Vallabhajosyula, Jacob C Jentzer, Jason N Katz, Willard N Applefeld, Adam May","doi":"10.1161/CIRCHEARTFAILURE.125.014161","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.014161","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a highly heterogeneous syndrome with persistently high mortality despite advances in therapies, including temporary mechanical circulatory support. The disparate results of trials on temporary mechanical circulatory support in CS suggest that improved strategies, including better patient selection, are needed in the context of CS heterogeneity. Notably, a microaxial flow pump device has recently shown a survival benefit in ST-segment-elevation myocardial infarction-associated CS in the DanGer Shock trial (Danish-German Cardiogenic Shock), marking a positive outcome amid many negative or neutral trials. As CS phenotyping becomes increasingly important for developing tailored therapeutic strategies, it is essential to identify factors contributing to variable phenotypes, including shock severity, cause, hemodynamic profile, ventricular function, shock pattern, and patient-centered factors that may influence microaxial flow pump candidacy. Successful CS management with a microaxial flow pump may be best guided by an individualized and proactive approach, tailored to each patient's risk profile and clinical course. It is rational to implement this strategy at centers capable of providing and managing advanced temporary mechanical circulatory support options while determining candidacy for advanced heart failure therapies. Our review underscores the importance of CS phenotyping and tailoring temporary mechanical circulatory support-particularly microaxial flow pump support-to patient-specific factors that are central to optimizing outcomes in CS management.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014161"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975943","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 in Evolution: A Special Dedicated Issue of <i>Circulation: Heart Failure</i> Guest Edited by David A. Morrow, MD, MPH.","authors":"James C Fang, Nancy K Sweitzer","doi":"10.1161/CIRCHEARTFAILURE.126.015032","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.015032","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e015032"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976021","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":"Hypoperfusion-Shock Continuum in Acute Decompensated Heart Failure.","authors":"Tijmen H Ris, Tim Balthazar, Paul Knaapen, Mariëlle C van de Veerdonk, Alexander Nap","doi":"10.1161/CIRCHEARTFAILURE.125.013797","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013797","url":null,"abstract":"<p><p>Acute decompensated heart failure is a clinical syndrome characterized by upregulation of neurohormonal compensatory mechanisms that, while intended to preserve organ perfusion as a response to reduced cardiac output, progressively exacerbate systemic congestion. Perfusion, defined by adequate oxygen delivery to the tissues, is more complex than simple cardiac output and arterial inflow, and is also significantly influenced by venous backpressure, as well as microcirculatory autoregulation. Therefore, as venous pressures continue to rise, these may ultimately contribute to hypoperfusion and, therefore, cardiogenic shock (CS). Other mechanisms, such as inflammation and increased organ capsular pressure, can contribute to further impairments in tissue oxygenation. This gradual and often clinically unrecognized deterioration from acute decompensated heart failure to heart failure-related CS (HF-CS) contrasts with acute myocardial infarction-related CS, where underlying compensatory mechanisms are more limited. Furthermore, prolonged and unrecognized hypoperfusion may further worsen HF-CS through progressive microcirculatory dysfunction with subsequent uncoupling of macrocirculation and microcirculation. At this point, normalization of macrocirculatory parameters may no longer restore tissue oxygenation. Early identification of hypoperfusion is, therefore, critical so that interventions targeting systemic hemodynamics may still improve tissue perfusion and reverse circulatory collapse. This review (1) outlines the pathophysiology of hypoperfusion in HF-CS; (2) summarizes invasive, biochemical, and imaging parameters to detect hypoperfusion; (3) phenotypes HF-CS profiles; and (4) proposes a monitoring framework for hypoperfusion in HF-CS.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e013797"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976024","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":"Way(s) Forward for Evidence Generation in Cardiogenic Shock.","authors":"Christina Lalani, Robert W Yeh","doi":"10.1161/CIRCHEARTFAILURE.126.014190","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014190","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014190"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975995","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 Society for Cardiovascular Angiography and Interventions Stage B Cardiogenic Shock.","authors":"Chirag Mehta, Phinnara Has, Aryan Mehta, Irene Vargas, Brian Osorio, Abraham Shin, Vaisali Chilamkurthy, Sahas Chandragiri, Daniel DePolo, Alexander Sweeting, Ryan Tudino, Heena Asnani, Corey E Ventetuolo, Daniel J Levine, Mark J Cunningham, J Dawn Abbott, Saraschandra Vallabhajosyula","doi":"10.1161/CIRCHEARTFAILURE.125.013814","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013814","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on the etiology, management, and outcomes of Society for Cardiovascular Angiography and Interventions (SCAI) stage B cardiogenic shock.</p><p><strong>Methods: </strong>From 2017 to 2022, adult patients (≥18 years) admitted to the medical, intermediate, and critical care units in a 6-hospital system were evaluated. SCAI stage B cardiogenic shock was defined as hypotension (systolic ≤90/mean ≤65 mm Hg) or hypoperfusion (lactate 2-5 mEq/L). Cardiac arrest, use of circulatory support, and noncardiac etiologies were excluded. The composite primary end point included transfer to a higher level of care, SCAI stage escalation, or in-hospital mortality. Multivariable analysis and mixed-effects regression models were used.</p><p><strong>Results: </strong>During this period, 500 patients (median age, 76 years; 56% men; 79% White) developed SCAI stage B cardiogenic shock (hypotension 18%, hypoperfusion 82%). The most common etiologies were heart failure (37%), arrhythmia (23%), and acute myocardial infarction (13%). The primary composite end point was noted in 135 patients (deterioration cohort). The deterioration cohort had comparable baseline characteristics to those who recovered, but before the primary outcome, had lower blood pressures, higher rates of renal (60% versus 33%) and hepatic (15% versus 4%) injury, less negative fluid balance (-0.30 versus -0.68 L), and greater diuretic resistance (21% versus 2%; <i>P</i><0.001). In a multivariable analysis, acute kidney injury-adjusted odds ratio 2.17 (95% CI, 1.11-4.22); <i>P</i>=0.02-and diuretic resistance-adjusted odds ratio 9.55 (95% CI, 2.61-34.89); <i>P</i>=0.001-were independently predictive of clinical deterioration. Patients with isolated hypotension had worse outcomes compared with those with isolated hypoperfusion.</p><p><strong>Conclusions: </strong>Among patients with SCAI stage B cardiogenic shock, a quarter of the population experienced clinical deterioration. Acute kidney injury and diuretic resistance in the preceding 24 hours were independently predictive of developing the primary end point.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013814"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218935","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":"Device-Related Adverse Events and Outcomes in Patients With Temporary Mechanical Circulatory Support Placed at Referral Centers Versus Cardiogenic Shock Hub Centers: An Observational Analysis.","authors":"Zachary A Patel, Meg K Ospina, Roxanne Mittelstaedt, Jacob Peller, Stephanie Samani, Charlotte Marchell, Kelly Ohlrich, Brady Gunn, Michael Varrone, Kaylen Dodson, Lindsey Bull, Hajj Jennifer, Mathew J Gregoski, Molly Silkowski, Michele Esposito, Ryan J Tedford, Jeffrey D McMurray, Lucas Witer, Arman Kilic, Brian A Houston, Anthony P Carnicelli","doi":"10.1161/CIRCHEARTFAILURE.125.013742","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013742","url":null,"abstract":"<p><strong>Background: </strong>Temporary mechanical support (tMCS) devices are often placed for cardiogenic shock (CS) at regional referral centers (RRCs) before transfer to CS hub centers (HCs). We sought to assess for differences in device-related adverse events (DRAEs) and outcomes between patients with tMCS placement for CS at an RRC before transfer to an HC compared with initial tMCS device placement at an HC.</p><p><strong>Methods: </strong>All patients with tMCS for CS from August 2021 to August 2024 at a single center were stratified by location of initial tMCS device placement. Baseline characteristics, adjudicated DRAEs, mortality, and unfavorable outcomes (death before discharge, heart transplant, or durable left ventricular assist device) were compared. DRAE rates were calculated as events/patient-week on tMCS. Multivariable logistic regression was performed to account for baseline differences. Kaplan-Meier and Cox regression were performed to compare mortality.</p><p><strong>Results: </strong>A total of 398 patients (77% HC-implanted, 23% RRC-implanted) were identified. RRC-implanted patients more commonly experienced cardiac arrest and had more advanced CS. DRAE prevalence was higher in RRC-implanted patients (any DRAE in 64% versus 33%), including bleeding (29% versus 12%), hemolysis (30% versus 18%), and vascular injury (22% versus 5%); <i>P</i><0.05 for all. The overall DRAE rate was 0.33 events/patient-week and was numerically higher among RRC-implanted than HC-implanted patients (0.65 versus 0.24 events/patient-week). RRC-implanted patients had higher unadjusted in-hospital mortality (odds ratio, 2.52 [95% CI, 1.52-4.18]; <i>P</i><0.001) and unfavorable outcomes (odds ratio, 2.55 [95% CI, 1.52-4.27]; <i>P</i><0.001). This finding was significant after adjustment for baseline differences, but not after adjustment for CS severity and cardiac arrest (in-hospital mortality odds ratio, 1.72 [95% CI, 0.95-3.12]; <i>P</i>=0.07; unfavorable outcome odds ratio, 1.60 [95% CI, 0.87-2.92]; <i>P</i>=0.13).</p><p><strong>Conclusions: </strong>Initial tMCS placement for CS at an RRC with transfer to an HC is associated with a higher DRAE prevalence and worse outcomes than initial tMCS placement at a CS HC. The higher mortality in RRC-implanted patients may be due to greater CS severity.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013742"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670948","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":"Twice the Trouble With Less Resistance: Epidemiology, Management, and Future Directions in Vasodilatory Cardiogenic Shock.","authors":"Siddharth M Patel, Sean van Diepen","doi":"10.1161/CIRCHEARTFAILURE.126.014191","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014191","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014191"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975959","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":"Stepping Down Without Stepping Back: Financial Implications of Impella 5.5 Management on Cardiovascular Stepdown Units.","authors":"Anthony P Carnicelli, Po Lin, Thomas G Di Salvo, Joyce W Wald, Arman Kilic, Brian A Houston","doi":"10.1161/CIRCHEARTFAILURE.125.014055","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.014055","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014055"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825842","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":"Between Physiology and Practice Culture: Unresolved Variability of Vasoactive Therapy in Cardiogenic Shock.","authors":"Jorge A Ortega-Hernández, Luca Baldetti, Jaime Hernández-Montfort","doi":"10.1161/CIRCHEARTFAILURE.126.014585","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014585","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014585"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975999","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}