Cardiogenic Shock in the Canadian Landscape: Key Concepts for the Practicing Clinician

Authors

  • Jordan D. Gibson, MD, FRCPC Department of Cardiac Sciences, University of Calgary, Foothills Medical Centre, Libin Cardiovascular Institute
  • Ayaaz K. Sachedina, MD, FRCPC Department of Cardiac Sciences, University of Calgary, Foothills Medical Centre, Libin Cardiovascular Institute

DOI:

https://doi.org/10.58931/cct.2025.112

Abstract

Cardiogenic shock (CS) is generally defined as a state of end-organ hypoperfusion secondary to an inability of the heart to deliver sufficient oxygenated blood to the tissues. Although CS is often initiated by an event that specifically affects the cardiovascular system, without prompt intervention, it can lead to a cascade of insults on other organ systems that result in additional morbidity and mortality. Despite advances in temporary mechanical circulatory support (MCS) technology over the past 2 decades, studies have consistently reported a 30% to 50% mortality rate for patients with CS at 6 to 12 months, though this rate may exceed 70% depending on the severity of the shock and individual patient factors. This review will provide an overview of key concepts in CS including current definitions, hemodynamic assessment, shock state classifications, and prognostication.

Author Biographies

Jordan D. Gibson, MD, FRCPC, Department of Cardiac Sciences, University of Calgary, Foothills Medical Centre, Libin Cardiovascular Institute

Dr. Gibson is currently the Chief Interventional Cardiology fellow at the University of Calgary. After graduating from medical school at the University of British Columbia, he completed his Internal Medicine and Cardiology residencies at the University of Calgary. He is also currently enrolled in a Master of Public Health Degree at Harvard University. His current research interests include health systems, cardiogenic shock, and structural interventional cardiology.

Ayaaz K. Sachedina, MD, FRCPC, Department of Cardiac Sciences, University of Calgary, Foothills Medical Centre, Libin Cardiovascular Institute

Dr. Sachedina is a Canadian Interventional Cardiologist at Foothills Medical Centre and the University of Calgary. He is the Director of CathSHOCK – Calgary Shock Symposium, the Lead for the Percutaneous Mechanical Circulatory Support Program in the Cardiac Catheterization Lab, and the coordinator of the Cardiogenic Shock Team Initiative at Foothills. He is also the program director for the Interventional Cardiology fellowship program at the University of Calgary. He completed his medical training at the University of Toronto, the University of Western Ontario, and the University of Texas where he completed a fellowship in Interventional Heart Failure at the Center for Advanced Cardiopulmonary Therapeutics and Transplant, Texas Medical Center, Houston. His focuses include coronary intervention, percutaneous mechanical support in the management of cardiogenic shock, and TAVI.

References

Jentzer JC, Pöss J, Schaubroeck H, Morrow DA, Hollenberg SM, Mebazaa A. Advances in the management of cardiogenic shock. Crit Care Med. 2023;51(9):1222–1233. DOI: https://doi.org/10.1097/CCM.0000000000005919

Waksman R, Pahuja M, Van Diepen S, Proudfoot AG, Morrow D, Spitzer E, et al. Standardized definitions for cardiogenic shock research and mechanical circulatory support devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC). Circulation. 2023;148(14):1113–1126. DOI: https://doi.org/10.1161/CIRCULATIONAHA.123.064527

Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. N Engl J Med. 1999;341(9):625–634. DOI: https://doi.org/10.1056/NEJM199908263410901

Berg DD, Bohula EA, Van Diepen S, Katz JN, Alviar CL, Baird-Zars, VM, et al. Epidemiology of shock in contemporary cardiac intensive care units: data from the Critical Care Cardiology Trials Network Registry. Circulation: Cardiovascular Quality and Outcomes 2019;12(3):e005618. DOI: https://doi.org/10.1016/S0735-1097(19)31274-4

Mendoza DD, Cooper HA, Panza JA. Cardiac power output predicts mortality across a broad spectrum of patients with acute cardiac disease. Am Heart J. 2007;153(3):366–370. DOI: https://doi.org/10.1016/j.ahj.2006.11.014

Zern EK, Wang D, Rambarat P, Bernard S, Paniagua SM, Liu EE, et al. Association of pulmonary artery pulsatility index with adverse cardiovascular events across a hospital-based sample. Circ Heart Fail. 2022;15(2):e009085. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.121.009085

Cesini S, Bhagra S, Pettit SJ. Low pulmonary artery pulsatility index is associated with adverse outcomes in ambulatory patients with advanced heart failure. J Card Fail. 2020;26(4):352–359. DOI: https://doi.org/10.1016/j.cardfail.2020.01.014

Kochav SM, Flores RJ, Truby LK, Topkara VK. Prognostic impact of pulmonary artery pulsatility index (PAPi) in patients with advanced heart failure: insights from the ESCAPE trial. J Card Fail. 2018;24(7):453–459. DOI: https://doi.org/10.1016/j.cardfail.2018.03.008

Merdji H, Levy B, Jung C, Ince C, Siegemund M, Meziani F. Microcirculatory dysfunction in cardiogenic shock. Ann Intensive Care. 2023;13(1):38. DOI: https://doi.org/10.1186/s13613-023-01130-z

Wijntjens GW, Fengler K, Fuernau G, Jung C, den Uil C, Akin S, et al. Prognostic implications of microcirculatory perfusion versus macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy. Eur Heart J Acute Cardiovasc Care. 2020;9(2):108–119. DOI: https://doi.org/10.1177/2048872619870035

Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv. 2019;94(1):29–37. DOI: https://doi.org/10.1002/ccd.28329

Thayer KL, Zweck E, Ayouty M, Garan AR, Hernandez-Montfort J, Mahr C, et al. Invasive hemodynamic assessment and classification of in-hospital mortality risk among patients with cardiogenic shock. Circ: Heart Fail. 2020;13(9):e007099. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.120.007099

Jentzer JC, van Diepen S, Barsness GW, Henry TD, Menon V, Rihal CS, et al. Cardiogenic shock classification to predict mortality in the cardiac intensive care unit. J AM Coll Cardiol. 2019;74(17):2117–2128. DOI: https://doi.org/10.1016/j.jacc.2019.07.077

Lawler PR, Berg DD, Park J-G, Katz JN, Baird-Zars VM, Barsness GW, et al. The range of cardiogenic shock survival by clinical stage: data from the Critical Care Cardiology Trials Network Registry. Critical Care Med. 2021;49(8):1293–1302. DOI: https://doi.org/10.1097/CCM.0000000000004948

Yerasi C, Case BC, Pahula M, Ben-Dor I, Waksman R. The need for additional phenotyping when defining cardiogenic shock. JACC Cardiovasc Interv. 2022;15(8):890-895 DOI: https://doi.org/10.1016/j.jcin.2021.12.039

Jentzer JC, Rayfield C, Soussi S, Berg DD, Kennedy JN, Sinha SS, et al. Advances in the staging and phenotyping of cardiogenic shock: Part 1 of 2. JACC: Adv. 2022;1(4):100120. DOI: https://doi.org/10.1016/j.jacadv.2022.100120

Jentzer JC, Rayfield C, Soussi S, Berg DD, Kennedy JN, Sinha SS, et al. Machine learning approaches for phenotyping in cardiogenic shock and critical illness. JACC: Adv. 2022;1(4):100126. DOI: https://doi.org/10.1016/j.jacadv.2022.100126

Baran DA, Long A, Badiye AP, Stelling K. Prospective validation of the SCAI shock classification: single center analysis. Catheter Cardiovasc Interv. 2020;96(7):1339–1347. DOI: https://doi.org/10.1002/ccd.29319

Schrage B, Dabboura S, Yan I, Hilal R, Neumann JT, Sorensen NA, et al. Application of the SCAI classification in a cohort of patients with cardiogenic shock. Catheter Cardiovasc Interv. 2020;96(3):E213-E219 DOI: https://doi.org/10.1002/ccd.28707

Hanson ID, Tagami T, Mando R, Kara Bella A, Dixon SR, Timmis S, et al. SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv. 2020;96(6):1137–1142. DOI: https://doi.org/10.1002/ccd.29139

Jentzer JC, Van Diepen S, Patel PC, Henry TD, Morrow DA, Baran DA, et al. Serial assessment of shock severity in cardiac intensive care unit patients. J Am Heart Assoc. 2023;12(23):e032748. DOI: https://doi.org/10.1161/JAHA.123.032748

Kapur NK, Kanwar M, Sinha SS, Thayer KL, Garan AR, Hernandez-Montfort J, et al. Criteria for defining stages of cardiogenic shock severity. J Am Coll Cardiol. 2022;80(3):185–198. DOI: https://doi.org/10.1016/j.jacc.2022.04.049

Pham HM, Van HD, Hoang LB, Phan PD, Tran VH. Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction. Medicine (Baltimore). 2023;102(37):e34689. DOI: https://doi.org/10.1097/MD.0000000000034689

Morici N, Frea S, Bertaina M, Sacco A, Corrada E, Sorini Dini C, et al. SCAI stage reclassification at 24 h predicts outcome of cardiogenic shock: insights from the Altshock‐2 registry. Catheter Cardiovasc Interv. 2023;101(1):22–32. DOI: https://doi.org/10.1002/ccd.30484

Wang JI, Lu DY, Mhs, Feldman DN, McCullough SA, Goyal P, et al. Outcomes of hospitalizations for cardiogenic shock at left ventricular assist device versus non–left ventricular assist device centers. J Am Heart Assoc. 2020;9(23):e017326. DOI: https://doi.org/10.1161/JAHA.120.017326

Papolos AI, Kenigsberg BB, Berg DD, Alviar CL, Bohula E, Burke JA, et al. Management and outcomes of cardiogenic shock in cardiac ICUs with versus without shock teams. J Am Coll Cardiol. 2021;78(13):1309–1317. DOI: https://doi.org/10.1016/j.jacc.2021.07.044

Lee F, Hutson JH, Boodhwani M, McDonald B, So, D, De Roock S, et al. Multidisciplinary code shock team in cardiogenic shock: a Canadian centre experience. CJC Open. 2020;2(4):249–257. DOI: https://doi.org/10.1016/j.cjco.2020.03.009

Moghaddam N, Van Diepen S, So D, Lawler PR, Fordyce CB. Cardiogenic shock teams and centres: a contemporary review of multidisciplinary care for cardiogenic shock. ESC Heart Fail. 2021;8(2):988–998. DOI: https://doi.org/10.1002/ehf2.13180

Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013;382(9905):1638–1645. DOI: https://doi.org/10.1016/S0140-6736(13)61783-3

Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA, et al. Extracorporeal life support in infarct-related cardiogenic shock. N Engl J Med. 2023;389(14):1286–1297. DOI: https://doi.org/10.1056/NEJMoa2307227

So DYF, Bagai A, Van Diepen S, Fordyce CB, Liu S, Avram R, et al. A pan-Canadian survey of cardiogenic shock management: a report from the Canadian Cardiovascular Research Collaboratory (C3) Cardiogenic Shock Working Group. Canadian J Cardiol. 2022;38(11):1732–1735. DOI: https://doi.org/10.1016/j.cjca.2022.07.021

Van Diepen S, Zheng Y, Senaratne JM, Tyrrell BD, Das D, Thiele H, et al. Reperfusion in patients with ST-segment–elevation myocardial infarction with cardiogenic shock and prolonged interhospital transport times. Circ Cardiovasc Interv. 2024;17(2):e013415. [ DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.123.013415

Aslam MI, Jani V, Lin BL, Dunkerly-Eyring B, Livingston CE, Ramachandran A, et al. Pulmonary artery pulsatility index predicts right ventricular myofilament dysfunction in advanced human heart failure. Eur J Heart Fail. 2021;23(2):339–341. DOI: https://doi.org/10.1002/ejhf.2084

Kanjanahattakij N, Sirinvaravong N, Aguilar F, Agrawal A, Krishnamoorthy P, Gupta S. High right ventricular stroke work index is associated with worse kidney function in patients with heart failure with preserved ejection fraction. Cardiorenal Med. 2018;8(2):123–129. DOI: https://doi.org/10.1159/000486629

Grodin JL, Drazner MH, Dupont M, Mullens W, Taylor DO, Starling RC, et al. A disproportionate elevation in right ventricular filling pressure, in relation to left ventricular filling pressure, is associated with renal impairment and increased mortality in advanced decompensated heart failure. Am Heart J. 2015;169(6):806–812. DOI: https://doi.org/10.1016/j.ahj.2015.02.017

Barker M, van Diepen S, Granger CB, Wong GC, Baird-Zars VM, Park JG, et al. Differences in care and outcomes in cardiogenic shock in cardiac intensive care units in the United States and Canada: CCCTN Registry insights. Can J Cardiol. Published online January 20, 2025. doi: 10.1016/j.cjca.2025.01.012 DOI: https://doi.org/10.1016/j.cjca.2025.01.012

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Published

2025-03-19

How to Cite

1.
Gibson JD, Sachedina AK. Cardiogenic Shock in the Canadian Landscape: Key Concepts for the Practicing Clinician. Can Cardiol Today [Internet]. 2025 Mar. 19 [cited 2025 Apr. 28];1(1):4–11. Available from: https://canadiancardiologytoday.com/article/view/1-1-Gibson_et_al

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