Inflammation and cardiovascular diseases: lessons that can be learned for the patient with cardiogenic shock in the intensive care unit

Purpose of review: In the past 12 years, atherosclerosis and the acute coronary syndromes have turned out to be thromboinflammatory diseases. Recent data suggest that inflammation also plays an important role in the pathogenesis and outcome of cardiogenic shock. This review will summarize recent advances in the understanding of the pathophysiology of cardiogenic shock related to the inflammatory network and will discuss recent findings in the treatment of patients with cardiogenic shock in relation to these new insights.

Recent findings: The glycoprotein IIb/IIIa antagonist abciximab has recently been found to be especially useful in the treatment of patients with cardiogenic shock undergoing coronary revascularization with stent implantation, reducing mortality in retrospective analyses from 40 to 50% down to 18 to 26%. Although it remains to be proved whether this is really due to their antiinflammatory effects, other drugs with clear antiinflammatory properties, like the nitric oxide synthase inhibitors L-NAME/L-NMMA, have recently been tested in small series of patients with refractory shock despite coronary revascularization based on the hypothesis that inflammation and impaired vasoreactivity are crucial for the pathogenesis and outcome of cardiogenic shock, with promising results. Other drugs, like a recently developed antibody fragment directed against C5 (pexelizumab) or high-dose statins, await testing in this population with a very high mortality rate.

Conclusion: The promising results of studies that tested a potential benefit of drugs with clear or potential antiinflammatory/immunomodulatory properties in patients with cardiogenic shock underscores the importance of the inflammatory network in the pathogenesis and outcome of this devastating complication of cardiovascular disease.