CHF Nov 2025 .pptx

1、,Manreet KanwarProfessor of MedicineDirector,Heart Failure and Pulmonary HypertensionCo-Director,Heart and Vascular Institution University of Chicago,Hemodynamic Criteria for Cardiogenic Shock Trials,Consultant,speaker and steering committee member for J and J Med Tech/AbiomedConsultant,speaker and

2、steering committee member for AbbottClinical Events Committee for BiVACOR,Disclosures,2,3,“If you cannot measure it,you cannot improve it”,Hemodynamic Goals in Cardiogenic Shock:Where we are,Cardiogenic Shockback in the day,CongestionHypoperfusion,HypotensionCongestion,19992023,CSWG-SCAI shock class

3、ification:(No hemodynamic criteria)for clinical practice,6,PAC utilization in CSremains low in community,Kapur,Kanwar,Burkhoff et al.Criteria for defining stages of shock severity.JACC 2022,7,Luca Baldetti,et al.Invasive Hemodynamic Monitoring in Acute Heart Failure and Cardiogenic Shock.Rev.Cardiov

4、asc.Med.2025,26(6),27034.,How we approach CS management in real life,But this does not help us design a clinical trial,DanGer:Hemodynamic data reviewed,but no goals were set,8,Moller et al.Effect of mAFP on hemodynamics of cardiogenic shock.JACC June 2025,9,10,11,Conclusion:Use of mAFP reduces pulmo

5、nary pressures,and LV filling pressures while maintaining hydraulic power output delivered to the body by the heart and mAFP(CPO),EF 20%acute MIHR 100/minBP 90/60 mm HgGDMTCO 3.8/CI 2.2Lactate 4Mortality 40%No compensatory physiology,EF 20%,chronic HFHR 100/minBP 90/60 mm HgGDMTCO 3.8/CI 2.2Lactate

6、4Mortality 20%Compensatory physiology,EF 20%acute MI with cardiac arrestHR 100/minBP 90/60 mm HgGDMTCO 3.8/CI 2.2Lactate 4Mortality 60%No compensatory physiology,But we cannot extrapolate this information to all shock phenotypes,Use of PAC has never been prospectively associated with improved surviv