AbstractBackgroundCardiogenic shock (CS) is a heterogenous, life-threatening condition burdened by high mortality rate. The clinical presentation and the pathophysiological mechanisms underlying CS in acute decompensated cardiogenic shock (ADHF-CS) in comparison with other acute etiology are completely different.PurposeAim of this study was to assess the differences between ADHF-CS and other acute etiology of CS, based on clinical features, echocardiographic and laboratory variables, type of support, outcomes.MethodsWe prospectively analyzed a cohort of CS patients consecutively admitted in an intensive cardiac care unit (ICCU) of a tertiary center in the period October 2020 to August 2024. This ICCU has a program for cardiac replacement therapy and it is inserted in a regional network for CS and advanced heart failure.ResultsA total of 109 patients (pts) with CS consecutively admitted in our ICCU were included in our analysis. ADHF-CS group was composed by 59 pts (male 84.7%, media age 60.4 years), with a significant less number of diabetic patients (25.4% respect of 44.0%, p 0.041). ADHF pts had no significative differences in severity of shock, they have similar SCAI stage, similar value of central venous pressure and lactate ad the admission but a significative lower value of central venous saturation (svcO2 54.8% vs 61.3%, p=0.026). Echocardiographic variables are very different in two groups: in ADHF-CS group the pts have major value of end diastolic diameter at the admission (left ventricle EDD admission 51.6 mm vs 64.4 mm, p< 0.001), lower left ventricular ejection fraction (EF 19.0% vs 23.2%, p=0.016), lower value of RVFAC (32.4% vs 38.1%) and a significative higher value of pulmonary pressure (44.8 mHg vs 35.5 mmHg, p= 0.001), no significative differences in left and right strain value. In ADHF group pts were supported with a major dose of vaso-inotropic drugs and dobutamine were used in 30% of patients in comparison with 14% of other group. The use of microaxial pump and VA-ECMO was no significative different, whereas IABP was used less frequent (41% in ADHF-CS vs 68%, p= 0.004), also ADHF-CS patients had less need of continuous renal replacement therapy (7.0% vs 28.0 p=0.04). ADHF CS patients had a significant liver disfunction (higher bilirubine and INR). ICCU- mortality was inferior in ADHF-CS without a significative value (16.9% vs 32.0%, p=0.065), a similar number of patient were implanted with LVAD but a significative higher number of pts were treated with heart transplantation (22.0% vs 5.0%, p=0.018).ConclusionsIn our cohort ADHF-CS population had similar baseline feature population, worse echocardiographic variables, major liver disfunction in comparison with other etiology of CS. ADHF-CS patients needed of higher dose of vaso-inotropic drug, similar mechanical circulatory support, excepted for a less use of IABP, they have a better survival rate in ICCU and they more often treated with successful heart transplantation.