Hemodynamic Assessment in Cardiogenic Shock Regarding the Etiology

Cardiogenic Shock Clinical Trial

Official title:

Hemodynamic Assessment in Cardiogenic Shock Regarding the Etiology

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03283995
• Other study ID #: 2017-15
• Secondary ID: 2017-A00563-50
• Status: Recruiting
• First received: September 13, 2017
• Last updated: April 10, 2018
• Start date: September 6, 2017
• Est. completion date: March 2019

Study information

• Verified date: April 2018
• Source: Assistance Publique Hopitaux De Marseille
• Contact: laurent BONELLO
• Phone: 0491968683
• Email: laurent.bonello[@]ap-hm.fr
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial Summary

The classic physiopathology of cardiogenic shock is explained by a systolic ventricular failure, responsible for a decrease in cardiac output associated with high systemic vascular resistances (SVR). This theory is currently challenged in light of the data collected in the SHOCK study, which assessed outcome of early revascularization versus initial medical stabilization, in cardiogenic shock following myocardial infarction.13 A sub-study highlighted depressed SVR in the population with ischemic cardiogenic shock, related to a systemic inflammatory response syndrome.14 Furthermore, mean FEVG was 30% in the SHOCK trial,13 with a similar distribution with post myocardial infarction heart failure patients without signs of shock.15-19 Thus, alteration of myocardial contractility can be only moderate in cardiogenic shock and isn't the only cause responsible for the hemodynamic instability.20 Recent studies suggest the important roles of the peripheral vascular system and neurohormonal system in the genesis and prolongation of cardiogenic shock.12 Vasodilation caused by nitrous oxide synthase activation27 explains the absence of compensating vasoconstriction observed during the SHOCK trial13, and leads to decreased systemic and coronary perfusion, thus increasing myocardial ischemia and initial ventricular dysfunction. 28,29 Cotter et al. conducted an interesting study of hemodynamic evaluation of various cardiac conditions where they observed a significant variability in the peripheral vascular status, with systemic vascular resistances collapsed in certain patients (similar to those observed in septic shock) and rather close to normal or very high resistances in other patients.21 However these data were obtained from a selected group of patients without differentiating the etiology of cardiogenic shock. Finally, the majority of available studies were limited to cardiogenic shock whose etiology was myocardial infarction.

Therapeutic management of cardiogenic shock is based in first intention on an inotropic support by Dobutamine.11,23 However, better outcomes on contractility and microcirculatory state have been observed with the use of a vasopressor support by Norepinephrine, suggesting the importance of SVR decreasing in genesis of cardiogenic shock.14,24 Recent reviews showed very few data on inotropic treatment and association with vasopressor support,22 hence the low level of recommendations in current guidelines.11,23

So far it is crucial to accurately characterize hemodynamic status and in particular the systemic vascular resistance for patients with cardiogenic shock. Important variabilities in hemodynamic profiles observed in Cooter's trial could explain the difficulty in defining an optimal therapeutic strategy.

the investigators hypothesize that the hemodynamic profile, particularly SVR, of patients with cardiogenic shock is different depending on their etiology. Ischemic cardiogenic shock should be characterized by lower SVR, in relation to a major role of systemic inflammatory response syndrome. On the contrary, non-ischemic cardiogenic shock could be associated with normal or elevated SVR, and thus could explain the variability in distribution of SVR.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 64
• Est. completion date: March 2019
• Est. primary completion date: September 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Persistent hypotension (systolic blood pressure <90 mmHg for at least 30 minutes or need for vasopressor support)

• Signs of visceral hypoperfusion (confusion, marbling, oliguria, hyperlactataemia), 11

• Lower heart rate (<1.8 L / min / m2) Adap Suitable or high filling pressures12

Exclusion Criteria:

• Pregnant or nursing women

• Major under guardianship

• Person staying in a health or social facility

• Non-beneficiaries of a social security scheme

• Persons deprived of liberty

• No one is able to give consent.

Related Conditions & MeSH terms

• Cardiogenic Shock
• Shock
• Shock, Cardiogenic

Intervention

Other:
• Cardiac Volume Monitoring VolumeView
hemodynamic measure

Device:
• echocardiography
hemodynamic measure

Locations

Country	Name	City	State
France	Assisatnce Publique Hopitaux de Marseille	Marseille

Sponsors (1)

Lead Sponsor	Collaborator
Assistance Publique Hopitaux De Marseille

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Monitoring by transpulmonary thermodilution (VolumeView		2 days