Phenotyping cardiogenic shock

Elric Zweck, Katherine L. Thayer, Ole K.L. Helgestad, Manreet Kanwar, Mohyee Ayouty, A. Reshad Garan, Jaime Hernandez-Montfort, Claudius Mahr, Detlef Wencker, Shashank S. Sinha, Esther Vorovich, Jacob Abraham, William O’neill, Song Li, Gavin W. Hickey, Jakob Josiassen, Christian Hassager, Lisette O. Jensen, Lene Holmvang, Henrik SchmidtHanne B. Ravn, Jacob E. Møller, Daniel Burkhoff, Navin K. Kapur*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Cardiogenic shock (CS) is a heterogeneous syndrome with varied presentations and outcomes. We used a machine learning approach to test the hypothesis that patients with CS have distinct phenotypes at presentation, which are associated with unique clinical profiles and in-hospital mortality. METHODS AND RESULTS: We analyzed data from 1959 patients with CS from 2 international cohorts: CSWG (Cardiogenic Shock Working Group Registry) (myocardial infarction [CSWG-MI; n=410] and acute-on-chronic heart failure [CSWG-HF; n=480]) and the DRR (Danish Retroshock MI Registry) (n=1069). Clusters of patients with CS were identified in CSWG-MI using the consensus k means algorithm and subsequently validated in CSWG-HF and DRR. Patients in each phenotype were further categorized by their Society of Cardiovascular Angiography and Interventions staging. The machine learning algorithms revealed 3 distinct clusters in CS: "non-congested (I)", "cardiorenal (II)," and "cardiometabolic (III)" shock. Among the 3 cohorts (CSWG-MI versus DDR versus CSWG-HF), in-hospital mortality was 21% versus 28% versus 10%, 45% versus 40% versus 32%, and 55% versus 56% versus 52% for clusters I, II, and III, respectively. The "cardiometabolic shock" cluster had the highest risk of developing stage D or E shock as well as in-hospital mortality among the phenotypes, regardless of cause. Despite baseline differences, each cluster showed reproducible demographic, metabolic, and hemodynamic profiles across the 3 cohorts. CONCLUSIONS: Using machine learning, we identified and validated 3 distinct CS phenotypes, with specific and reproducible associations with mortality. These phenotypes may allow for targeted patient enrollment in clinical trials and foster development of tailored treatment strategies in subsets of patients with CS.

Original languageEnglish
Article numbere020085
JournalJournal of the American Heart Association
Volume10
Issue number14
ISSN2047-9980
DOIs
Publication statusPublished - 20. Jul 2021

Keywords

  • Cardiogenic shock
  • Clusters
  • Heart failure
  • Hemodynamics
  • Machine learning
  • Myocardial infarction
  • Phenotypes

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