Risk stratification in cardiogenic shock remains challenging, particularly when vasoplegia contributes to hemodynamic instability. An analysis presented at the American Heart Association (AHA) 2025 Scientific Sessions evaluated the prognostic value of the diastolic shock index in cardiogenic shock using data from the SHOCK trial database.

The study included patients with cardiogenic shock secondary to acute myocardial infarction. Patients with concomitant septic shock were excluded. Of 302 patients in the database, 244 formed the final analytic cohort. Receiver operating characteristic analyses assessed DSI discrimination for 30-day, 6-month, and 12-month mortality at randomization, 6 hours, and 24 hours. Associations between DSI, cardiac output, and systemic vascular resistance were examined using invasive hemodynamic measurements. Multivariable logistic regression evaluated mortality risk.

At randomization, the area under the receiver operating characteristic curve for DSI was 0.59 for 30-day mortality, 0.61 for 6-month mortality, and 0.62 for 12-month mortality. At 6 hours post-randomization, corresponding values increased to 0.62, 0.66, and 0.66. At 24 hours post-randomization, discrimination further improved to 0.69, 0.68, and 0.68, respectively. In multivariable analysis, each unit increase in DSI at 6 hours was associated with higher odds of 30-day mortality (odds ratio 1.61; p = 0.054), 6-month mortality (odds ratio 2.00; p = 0.022), and 12-month mortality (odds ratio 1.90; p = 0.035). Correlation analyses demonstrated a significant negative association between DSI and cardiac output at 6 hours (p = 0.01) and between DSI and systemic vascular resistance at 24 hours (p = 0.02).

These findings indicate that elevated DSI reflects both impaired cardiac output and reduced vascular tone in cardiogenic shock. Identification of this mixed cardiogenic-vasoplegic phenotype using early DSI measurements may support more precise hemodynamic assessment and risk stratification.