deep phenotyping: staging & grading cardiogenic shock is ......cswg report – under review 2019...
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Deep phenotyping: Staging & Grading Cardiogenic Shock
Is This Necessary?
Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine
Interventional Cardiology & Advanced Heart Failure Programs Executive Director, The Cardiovascular Center for Research & Innovation
Relevant Disclosures
Research Funding & Speaker/Consulting Honoraria: Abiomed, Abbott, Boston Scientific, LivaNova, MD Start, Precardia
Herbert J. Levine Foundation
Tufts Medical Center
Charlton Award Tufts Medical Center
RO1HL139785, RO1H133215
How Severe is Cardiogenic Shock in this Trial?
What would you use to support this patient profile? 1. Drug therapy 2. VA-ECMO 3. Impella CP 4. IABP
Randomized Trials without Defining Shock Severity
Without clear definitions for cardiogenic shock severity we will not improve outcomes for patients
Ouweneel and Henriques JACC 2017
IABP vs Impella ?
Here are the Problems No Stratification + No Shock Algorithm
INSERT ANY DEVICE
HERE
Noise Drives Non-Significance
Why are we here today?
Hemodynamic Support Options Exist
IABP SHOCK II IMPRESS Trial (n=130)
Why are we here today? Cardiogenic Shock is a Complex
Multi-factorial Syndrome
CLINICAL CATEGORIES Acute Myocardial Infarction STEMI vs NSTEMI vs RVMI Post-AMI Complications Dilated Cardiomyopathy
Non-Dilated Cardiomyopathy Myocarditis vs Post-Partum
Post-Cardiotomy Valvular Shock
Other
PATHOPHYSIOLOGIC GROUPS Cardiac vs Circulatory Collapse
LV-Dominant RV-Dominant BiV-Dominant
Hemo-Metabolic Cardiorenal
Cardiopulmonary (RV-PA-LA Axis) Valvular Shock
Vascular Resistance
The Cardiogenic Shock Working Group
The mission of the CGWG is to improve clinical outcomes for cardiogenic shock by promoting rigorous scientific investigation inclusive of a multi-center registry of patients receiving short-term mechanical circulatory support for cardiogenic shock.
10 Primary Data-Contributing Centers 6 Centers Processing IRB and Data Agreements
• Largest contemporary US registry of Cardiogenic Shock
• >2000 shock patients inclusive of MI and HF (2017-2019)
• Real world experience across secondary & tertiary centers
• Hemodynamic data for over 1100 patients in shock
• Inclusive of all acute mechanical circulatory support devices
Classes and Stages A Game-Changer for Heart Failure
Proposed SCAI Stages of CG Shock
SCAI Stages and In-Hospital Mortality
CSWG Report – Under Review 2019
Heart Failure Classes, Stages, and Levels INTERMACS Levels Identified High Risk Patients
Treatment Intensity & In-Hospital Mortality
CSWG Report – Under Review 2019
Levels of Cardiogenic Shock
CSWG Report – Under Review 2019
Invasive Hemodynamics and Outcomes
CSWG Report – Under Review 2019
Invasive Hemodynamics and Outcomes
CSWG Report – Under Review 2019
Hemodynamic and Metabolic Parameters
CSWG Report – Under Review 2019
Stages and Levels of Cardiogenic Shock
CSWG Report – Under Review 2019
Challenges with Phenotyping Shock
Sanjiv Shah, MD (Medscape: HFpEF)
Challenges with Phenotyping Shock
Sanjiv Shah, MD (Medscape: HFpEF)
CSWG Research Program Proposal
Retrospective Registry
Retrospective Phenotypes Registry (Cluster Analysis)
(Machine Learning)
Stages and Levels Development Cohort
Testing Cohort Simulation Study
Prospective Registry
Longitudinal Outcomes Escalation Analysis
Focused RCT Development
Acknowledgements CSWG Board Members
Navin K. Kapur, MD A. Reshad Garan, MD
Jaime Hernandez-Montfort, MD Claudius Mahr, MD
Daniel Burkhoff, MD PhD
Research Team Development Team Sarah Newman (Coordinator) Ryan Kelly (CVCRI Lead Administrator) Katherine Thayer (Statistician) Erin Gilbert (Business Development) Jillian Haywood (Coordinator) Nancy Wetherbee (Industry Relations) Moyhee Ayouty (Res. Assoc) Debbie Slater (Research Administrator) Elric Zweck (Res. Assoc)
Deep phenotyping: Staging & Grading Cardiogenic Shock
Is This Necessary?
Navin K. Kapur, MD, FACC, FSCAI, FAHA [email protected]