Classical definition of cardiogenic shock (CS) combine a systolic blood pressure (SBP)<90mmHg with a low cardiac output and tissue hypoperfusion. By contrast, in practice, the spectrum of presentations is, by far, more complex. We compared presentation and prognosis between hypotensive and normotensive low cardiac output patient.

FRENSHOCK was a multicenter, prospective, observational survey realized between 04 and 10.2016 in 48 centers in France. Patients were included if they met the criteria below:

– a low cardiac output (SBP<90mmHg and/or need of amines, and/or a low cardiac index <2.2L/min/m² on TTE or Swan-Ganz);

– clinical, radiological, biological (NTproBNP or BNP), echocardiography, or invasive hemodynamics overload signs;

– a clinical and/or biological hypoperfusion (lactates>2mmol/L, hepatic or renal failure).

A total of 772 patients were included (male 72%, median age 66y): 678 with SBP<90mmHg (group A) and 94 with a proven low cardiac output without hypotension (group B). Group B patients have more chronic renal failure, more idiopathic dilated cardiomyopathy, more previous treatment by furosemide, and CS was more frequently caused by drug inobservance. They have less marbles, lower LVEF, more mitral insufficiency and higher pH but without significant difference for lactate. They were more treated by furosemide (95 vs 81%, P=0.001), but less by dobutamine (71 vs 80%, P=0.002), norepinephrine (21 vs 58%, P=0.01), epinephrine (4 vs 13%, P=0.012), invasive mechanical ventilation (15 vs 41%, P<0.01), renal replacement therapy (3 vs 18%, P<0.001) and circulatory support (11 vs 20%, P=0.035). At 30 days, no difference in mortality, heart transplantation and/or VAD implantation was observed (Figure 1).

Normotensive patients with low cardiac output, overload and hypoperfusion signs present similar prognosis to classical CS. So, current definitions for CS could be challenged to avoid underestimate these patients.