Cardiogenic shock: Who benefits from heart replacement therapy?

Abstract

Background: The characteristics of patients requiring heart replacement therapy (HRT) in cardiogenic shock (CS) are poorly described. This study aims to characterize the clinical profile of CS patients undergoing HRT. Methods: FRENSHOCK is a prospective registry including 772 CS patients from 49 centres. HRT included heart transplantation (HTx) and ventricular assist devices (VADs). The primary endpoint was the rate of in-hospital HRT. The secondary endpoint was the rate of HRT performed between discharge and 1-year follow-up. Results: Among 772 patients, 49 (6.3 %) underwent in-hospital HRT (11 LVADs, 4 BiVADs, 34 HTx), including 10 (20.4 %) who died before discharge. Multivariate analysis identified several independent factors for in-hospital HRT: Prior ICD (aOR 1.18 [1.09–1.27], p < 0.01), signs/symptoms of right heart failure (aOR 1.06 [1.01–1.12] p = 0.02), bilirubin level ≥ 18.9 mg/L (aOR 1.06 [1.01–1.12], p = 0.02), use of dobutamine (aOR 1.11 [1.01–1.23], p = 0.049) or levosimendan (aOR 1.10 [1.01–1.21], p = 0.04), and acute mechanical circulatory support (aMCS) (aOR 1.16 [1.08–1.25], p < 0.01). Subsequently, 29 patients (3.8 % of the cohort, 5.6 % of in-hospital survivors) underwent HRT between discharge and 1-year follow-up. Ventricular arrhythmia (aOR 1.08 [1.01–1.17], p = 0.04) and aMCS (aOR 1.23 [1.12–1.35], p < 0.01) were associated with HRT between discharge and the 1-year follow-up. Conclusion: In this large cohort of unselected CS patients, HRT was performed in more than 10 % of cases (6.3 % in-hospital and 3.8 % between discharge and 1-year follow-up), with a comparable in-hospital mortality rate to non-HRT patients. Further studies are needed to optimize the selection criteria for HRT in CS patients.