Tailored Therapies for Cardiogenic Shock in Hypertrophic Cardiomyopathy: Navigating Emerging Strategies.

IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Development and Disease Pub Date : 2024-12-11 DOI:10.3390/jcdd11120401
George E Zakynthinos, Ioannis Gialamas, Vasiliki Tsolaki, Panteleimon Pantelidis, Athina Goliopoulou, Maria Ioanna Gounaridi, Ioanna Tzima, Andrew Xanthopoulos, Konstantinos Kalogeras, Gerasimos Siasos, Evangelos Oikonomou
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Abstract

Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous cardiac disorder, often complicated by cardiogenic shock, a life-threatening condition marked by severe cardiac output failure. Managing cardiogenic shock in HCM patients presents unique challenges due to the distinct pathophysiology of the disease, which includes dynamic left ventricular outflow tract obstruction, diastolic dysfunction, and myocardial ischemia. This review discusses current and emerging therapeutic strategies tailored to address the complexities of HCM-associated cardiogenic shock and other diseases with similar pathophysiology that provoke left ventricular outflow tract obstruction. We explore the role of pharmacological interventions, including the use of vasopressors and inotropes, which are crucial in stabilizing hemodynamics but require careful selection to avoid exacerbating the outflow obstruction. Additionally, the review highlights advancements in mechanical circulatory support devices such as extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs), which have become vital in the acute management of cardiogenic shock. These devices provide temporary support and bridge patients to recovery, definitive therapy, or heart transplantation, which remains a critical option for those with end-stage disease. Furthermore, the review delves into the latest research and clinical trials that are refining these therapeutic approaches, ensuring they are optimized for HCM patients. The impact of these treatments on patient outcomes, including survival rates and quality of life, is also critically assessed. In conclusion, this review underscores the importance of a tailored therapeutic approach in managing cardiogenic shock in HCM patients, integrating pharmacological and mechanical support strategies to improve outcomes in this high-risk population.

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肥厚性心肌病心源性休克的量身定制治疗:导航新兴策略。
肥厚性心肌病(HCM)是一种复杂的异质心脏疾病,常并发心源性休克,以严重的心输出量衰竭为特征,危及生命。HCM患者心源性休克的管理面临着独特的挑战,因为该疾病具有独特的病理生理学,包括动态左心室流出道梗阻、舒张功能障碍和心肌缺血。这篇综述讨论了当前和新兴的治疗策略,以解决hcm相关的心源性休克和其他具有类似病理生理的引起左心室流出道阻塞的疾病的复杂性。我们探讨了药物干预的作用,包括血管加压药和收缩药物的使用,它们对稳定血流动力学至关重要,但需要谨慎选择,以避免加剧流出梗阻。此外,该综述强调了机械循环支持装置的进展,如体外膜氧合(ECMO)和左心室辅助装置(lvad),它们在心源性休克的急性治疗中变得至关重要。这些装置提供暂时的支持,并为患者提供康复、最终治疗或心脏移植的桥梁,这仍然是终末期疾病患者的关键选择。此外,该综述深入研究了最新的研究和临床试验,这些研究和试验正在改进这些治疗方法,确保它们对HCM患者进行优化。这些治疗对患者预后的影响,包括生存率和生活质量,也被严格评估。总之,本综述强调了在HCM患者心源性休克管理中定制治疗方法的重要性,结合药物和机械支持策略来改善这一高危人群的预后。
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来源期刊
Journal of Cardiovascular Development and Disease
Journal of Cardiovascular Development and Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.60
自引率
12.50%
发文量
381
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