{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T07:09:05Z","timestamp":1772521745939,"version":"3.50.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Artif. Intell."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiogenic shock (CS) is a life-threatening condition characterized by clinical heterogeneity and high mortality. A \u201cone-size-fits-all\u201d approach to management may be suboptimal. We aimed to identify distinct clinical phenotypes of CS using an unsupervised machine learning approach and to characterize their associated mortality and SCAI stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of 1,513 patients with CS from the Gulf registry. An unsupervised machine learning methodology was employed, using agglomerative hierarchical clustering on seven key continuous variables (Age, Ejection Fraction, Mean Arterial Pressure, Lactate, pH, Creatinine, and Alanine Transaminase) to identify patient subgroups. The optimal number of clusters was determined using a combination of quantitative metrics and clinical interpretability. The identified phenotypes were then validated against external outcomes, including in-hospital mortality and SCAI Shock Stage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four distinct clinical phenotypes were identified. Phenotype 1 (\u201cCompensated Low-Risk,\u201d\n                      <jats:italic>n<\/jats:italic>\n                      = 492, 32.5%) had the lowest mortality rate (22.4%). Phenotype 2 (\u201cMetabolic Dysfunction,\u201d\n                      <jats:italic>n<\/jats:italic>\n                      = 418, 27.6%) was characterized by severe left ventricular dysfunction and had a mortality of 41.9%. Phenotype 3 (\u201cMulti-organ Failure,\u201d\n                      <jats:italic>n<\/jats:italic>\n                      = 204, 13.5%) presented with severe metabolic, renal, and hepatic derangement and had the highest mortality (78.4%). Phenotype 4 (\u201cElderly Decompensated,\u201d\n                      <jats:italic>n<\/jats:italic>\n                      = 399, 26.4%) included older patients with moderate metabolic dysfunction and had a mortality of 60.7%. A steep mortality gradient was observed across the phenotypes (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), and the distribution of SCAI shock stages differed significantly, aligning with the risk profile of each cluster.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a large, contemporary registry of CS patients, an unsupervised machine learning approach successfully identified four distinct and prognostically significant phenotypes. These data-driven phenotypes, characterized by unique clinical and biomarker profiles, provide a novel framework for risk stratification that moves beyond traditional classification systems and may facilitate the development of personalized therapeutic strategies for cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frai.2026.1744896","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:47:43Z","timestamp":1772520463000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenotyping cardiogenic shock: an insight from the gulf cardiogenic shock registry"],"prefix":"10.3389","volume":"9","author":[{"given":"Ahmed","family":"Elmahrouk","sequence":"first","affiliation":[{"name":"King Faisal Specialist Hospital and Research Centre - Jeddah","place":["Jeddah, Saudi Arabia"]},{"name":"Faculty of Medicine, Tanta University","place":["Tanta, Egypt"]}]},{"given":"Amin","family":"Daoulah","sequence":"additional","affiliation":[{"name":"King Faisal Specialist Hospital and Research Centre - Jeddah","place":["Jeddah, Saudi Arabia"]}]},{"given":"Ahmed","family":"Jamjoom","sequence":"additional","affiliation":[{"name":"King Faisal Specialist Hospital and Research Centre - Jeddah","place":["Jeddah, Saudi Arabia"]}]},{"given":"Nooraldaem","family":"Yousif","sequence":"additional","affiliation":[{"name":"Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre","place":["Awali, Bahrain"]}]},{"given":"Wael","family":"Almahmeed","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Abu Dhabi","place":["Abu Dhabi, United Arab Emirates"]}]},{"given":"Prashanth","family":"Panduranga","sequence":"additional","affiliation":[{"name":"National Heart Center, Royal Hospital","place":["Muscat, Oman"]}]},{"given":"Abdulrahman","family":"Arabi","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation","place":["Doha, Qatar"]}]},{"given":"Omar","family":"Kanbr","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Elrazi University","place":["Khartoum, Sudan"]}]},{"given":"Hatem M.","family":"Aloui","sequence":"additional","affiliation":[{"name":"King Saud Medical City","place":["Riyadh, Saudi Arabia"]}]},{"given":"Mohammed","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Prince Khaled Bin Sultan Cardiac Center","place":["Khamis Mushait, Saudi Arabia"]}]},{"given":"Badr","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Prince Sultan Cardiac Center","place":["Riyadh, Saudi Arabia"]}]},{"given":"Shaber","family":"Seraj","sequence":"additional","affiliation":[{"name":"TH Chan School of Medicine, University of Massachusetts Chan Medical School","place":["Worcester, MA, United States"]}]},{"given":"Adnan","family":"Hussien","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital London","place":["Jeddah, Saudi Arabia"]}]},{"given":"Waleed","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Cardiac Sciences Department, King Saud University","place":["Riyadh, Saudi Arabia"]}]},{"given":"Mohammed A.","family":"Qutub","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Abdulaziz University","place":["Jeddah, Saudi Arabia"]}]},{"given":"Mokhtar","family":"Kahin","sequence":"additional","affiliation":[{"name":"International Medical Center","place":["Jeddah, Saudi Arabia"]}]},{"given":"Abdullah","family":"Alenezi","sequence":"additional","affiliation":[{"name":"Chest Diseases Hospital","place":["Kuwait City, Kuwait"]}]},{"given":"Mohamed Ajaz","family":"Ghani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Madinah Cardiac Center","place":["Almadinah, Saudi Arabia"]}]},{"given":"Taher","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bugshan General Hospital","place":["Jeddah, Saudi Arabia"]}]},{"given":"Rajesh","family":"Rajan","sequence":"additional","affiliation":[{"name":"Al-Amiri Hospital","place":["Kuwait City, Kuwait"]}]},{"given":"Said","family":"Al Maashani","sequence":"additional","affiliation":[{"name":"Salalah Heart Center, Sultan Qaboos Hospital","place":["Salalah, Oman"]}]},{"given":"Abdulwali","family":"Abohasan","sequence":"additional","affiliation":[{"name":"Central Hospital Hafr Albatin","place":["Hafr Albatin, Saudi Arabia"]}]},{"given":"Mohammed","family":"Balghith","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences College of Public Health and Health Informatics","place":["Riyadh, Saudi Arabia"]}]},{"given":"Ziad","family":"Dahdouh","sequence":"additional","affiliation":[{"name":"King Faisal Specialist Hospital and Research Centre","place":["Riyadh, Saudi Arabia"]}]},{"given":"Abdulrahman M.","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"King Salman Heart Center, King Fahad Medical City","place":["Riyadh, Saudi Arabia"]}]},{"given":"Ibrahim A. M","family":"Abdulhabeeb","sequence":"additional","affiliation":[{"name":"King Abdulaziz Specialist Hospit","place":["Aljawf, Saudi Arabia"]}]},{"given":"Mohammed","family":"Al Jarallah","sequence":"additional","affiliation":[{"name":"Al-Amiri Hospital","place":["Kuwait City, Kuwait"]}]},{"given":"Mubarak Abdulhadi","family":"Aldossari","sequence":"additional","affiliation":[{"name":"King Saud Medical City","place":["Riyadh, Saudi Arabia"]}]},{"given":"Harvey","family":"Anthony","sequence":"additional","affiliation":[{"name":"The Royal Hospital National Heart Center","place":["Muscat, Oman"]}]},{"given":"Mohammed Awad Ashour Awad","family":"Ashour","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation","place":["Doha, Qatar"]}]},{"given":"Tarique Shahzad","family":"Chachar","sequence":"additional","affiliation":[{"name":"Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre","place":["Awali, Bahrain"]}]},{"given":"Hassan","family":"Khan","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Abu Dhabi","place":["Abu Dhabi, United Arab Emirates"]}]},{"given":"Abeer M.","family":"Shawky","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University","place":["Cairo, Egypt"]},{"name":"Dr Erfan and Bagedo General Hospital","place":["Jeddah, Saudi Arabia"]}]},{"given":"Youssef","family":"Elmahrouk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tanta University","place":["Tanta, Egypt"]}]},{"given":"Amir","family":"Lotfi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School","place":["Worcester, MA, United States"]}]},{"given":"Amr","family":"Arafat","sequence":"additional","affiliation":[{"name":"Research and Innovation Institute, Ministry of Defense Health Services","place":["Riyadh, Saudi Arabia"]},{"name":"Prince Sultan Cardiac Center","place":["Riyadh, Saudi Arabia"]}]}],"member":"1965","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2025-099208","article-title":"Timing of mechanical ventilation and its association with in-hospital outcomes in patients with cardiogenic shock following ST-elevation myocardial infarction: a multicentre observational study","volume":"15","author":"Arabi","year":"2025","journal-title":"BMJ Open"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1002\/ccd.28329","article-title":"SCAI clinical expert consensus statement on the classification of cardiogenic shock","volume":"94","author":"Baran","year":"2019","journal-title":"Catheter. 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