New definitions of cardiogenic shock: epidemiological, physiopathological and prognostic bases

Abstract

Cardiogenic shock (CS) is defined as organ hypoperfusion secondary to impaired cardiac output. It corresponds to a severe form of heart failure, most often acute, the main etiology of which remains myocardial infarction, but non-ischemic causes are now predominant (50-60%). Its classic physiopathology associates systolic and diastolic myocardial dysfunction, pulmonary and venous congestion, and a systemic inflammatory response syndrome. But several borderline CS presentation or mixed forms with euvolemia and/or vasoplegia exist. Thus, it is necessary to review the usual definition of CS and its positive and etiological diagnostic approach in order to integrate these different presentations and evolutions. Based on easily accessible clinical, biological and imaging parameters, the FRENSHOCK definition allow a rapid and sensitive CS diagnosis. In parallel the SCAI classification integrate the concept of evolution of CS allowing to stratify its prognosis and to guide its management (timing and intensity). Better dissemination of these definitions should make it possible to harmonize CS management both from a clinical and research point of view, and thus may allow an improvement in the prognosis of these patients.