Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 83(5), 595–608. https://doi.org/10.1016/j.jacc.2023.11.019 Dr. Kriti Puri et al.
Points
- The study addresses the lack of data on cardiogenic shock (CS) in pediatric acute decompensated heart failure (ADHF)
- 26% of pediatric ADHF hospitalizations involved CS, with associated worse systolic function and higher B-type natriuretic peptide concentration
- Children with CS had an increased risk of in-hospital mortality, with each higher CS stage showing a strong association with greater inpatient mortality.
- Mechanical ventilation and circulatory support were more prevalent in children presenting with CS.
- The introduction of a modified shock classification demonstrated a robust association with increasing mortality, highlighting the severity and prognostic implications of CS in pediatric patients.
Summary
The research aimed to address the paucity of data regarding the epidemiology, clinical features, and outcomes of children experiencing cardiogenic shock (CS) in the context of acute decompensated heart failure (ADHF). The study comprehensively analyzed consecutive ADHF hospitalizations involving patients under 21 years of age from a large single-center retrospective cohort. The findings revealed that CS occurred in 26% of the hospitalizations for ADHF, with children presenting in CS exhibiting worse systolic function, higher B-type natriuretic peptide concentration, and more frequent early severe renal and liver injury compared to those without CS. Notably, children with CS were at an increased risk of in-hospital mortality, with each higher CS stage demonstrating a robust association with greater inpatient mortality.
Specifically, the study identified critical clinical characteristics associated with CS in pediatric ADHF hospitalizations, including the prevalence of mechanical ventilation and mechanical circulatory support in children presenting with CS. Furthermore, the research introduced a modified Society for Cardiovascular Angiography and Interventions shock classification, which demonstrated a strong association with increasing mortality, providing valuable insights into the severity and prognostic implications of CS in pediatric patients with ADHF.
In summary, the study shed light on the significant burden of CS in pediatric ADHF hospitalizations and its independent association with hospital mortality. The findings underscore the critical need for a deeper understanding of CS in children and the development of targeted interventions to improve outcomes in this vulnerable patient population.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723081469
References Puri, K., Jentzer, J. C., Spinner, J. A., Hope, K. D., Adachi, I., Tume, S. C., Tunuguntla, H. P., Choudhry, S., Cabrera, A. G., & Price, J. F. (2024). Clinical Presentation, Classification, and Outcomes of Cardiogenic Shock in Children. Journal of the American College of Cardiology, 83(5), 595–608. https://doi.org/10.1016/j.jacc.2023.11.019
