Unraveling Heart Failure Cardiogenic Shock Profiles and Pathways
Bibliographic record
Abstract
This article refers to 'Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock' by J. Sundermeyer et al., published in this issue on pages 432-444.Cardiogenic shock (CS) results from both non-ischaemic and ischaemic cardiac insults, ultimately leading to an acute deterioration in cardiac output associated with multi-system end-organ malperfusion with or without congestion.[1][2][3][4][5] In contrast to acute myocardial infarction (AMI)-CS where early revascularization and ventricular unloading may be of benefit, less is known about heart failure (HF)-CS with regard to targeted therapeutic strategies and mortality remains upwards of 30-50%.[1][2][3][4][5][6][7][8][9][10] This is due to the diverse array of non-ischaemic aetiologies and underlying pathophysiology; the variable severity, chronicity, congestive profiles and risk modifiers of the clinical HF-CS presentation; and the paucity of randomized trials to guide evidence-based recommendations.[1][2][3][4][5][6][7][8][9][10] In this issue of the Journal, Sundermeyer et al. 6 present key findings from an international, multicentre, observational non-ischaemic CS registry of 1030 adults with de novo (DNHF-CS; 47.2%) or acute-on-chronic (ACHF-CS; 52.8%) HF-CS from 16 tertiary care centres across five European countries over 2010-2021.Those with ACHF-CS were more often men (odds ratio [OR] 2.88, p < 0.001) and had more cardiac risk factors and comorbidities (diabetes OR 1.92, p < 0.001; atrial fibrillation OR 2.71, p < 0.001) despite being less likely to be resuscitated (OR 0.61, p = 0.006) or to need mechanical ventilation (OR 0.62, p = 0.011).6 They also had greater severity of CS Society for Coronary Angiography and Interventions (SCAI) stage C (OR 1.48, p = 0.110; SCAI stage D OR 2.75, p < 0.001; SCAI stage E OR 2.74, p < 0.001); more dialysis-dependent acute kidney injury (OR 1.42), pulmonary congestion (OR 1.51), and sepsis (OR 1.67); and 10% higher 30-day mortality rates (hazard ratio 1.38, p = 0.005) even after adjusting for confounders (age, sex, SCAI class, lactate, pH, resuscitation, mechanical ventilation).6 The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.005 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.008 | 0.004 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.012 | 0.015 |
| Insufficient payload (model declined to judge) | 0.008 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".