{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:03:07Z","timestamp":1773705787085,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T00:00:00Z","timestamp":1662422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Cardiogenic shock remains a deadly complication of acute on chronic decompensated heart failure (ADHF-CS). Despite its increasing prevalence, it is incompletely understood and therefore often misdiagnosed in the early phase. Precise diagnosis of the underlying cause of CS is fundamental for undertaking the correct therapeutic strategy. Temporary mechanical circulatory support (tMCS) is the mainstay of management: identifying and selecting optimal patients through understanding of the hemodynamics and a prompt profiling and timing, is key for success. A recent statement from the American Heart Association provided pragmatic suggestions on tMCS device selection, escalation, and weaning strategies. However, several areas of uncertainty still remain in clinical practice. Accordingly, we present an overview of the main pitfalls that can occur during patients\u2019 management with tMCS through a clinical case. This case illustrates the strict interdependency between left ventricular unloading and right ventricular dysfunction in the case of low filling pressures. Moreover, it further illustrates the pivotal role of stepwise escalation of therapy in a patient with an ADHF-CS and its peculiarities as compared to other forms of acute heart failure.<\/jats:p>","DOI":"10.3390\/jpm12091463","type":"journal-article","created":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T22:33:01Z","timestamp":1662503581000},"page":"1463","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Left Ventricular Unloading in Acute on Chronic Heart Failure: From Statements to Clinical Practice"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8150-474X","authenticated-orcid":false,"given":"Alice","family":"Sacco","sequence":"first","affiliation":[{"name":"\u201dDe Gasperis\u201d Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuccia","family":"Morici","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Gnocchi, Dipartimento Cardio-Respiratorio, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo Andrea","family":"Oreglia","sequence":"additional","affiliation":[{"name":"\u201dDe Gasperis\u201d Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9560-5138","authenticated-orcid":false,"given":"Guido","family":"Tavazzi","sequence":"additional","affiliation":[{"name":"Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia Italy, 27100 Pavia, Italy"},{"name":"Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Villanova","sequence":"additional","affiliation":[{"name":"\u201dDe Gasperis\u201d Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Colombo","sequence":"additional","affiliation":[{"name":"\u201dDe Gasperis\u201d Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Garatti","sequence":"additional","affiliation":[{"name":"\u201dDe Gasperis\u201d Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele Giovanni","family":"Mondino","sequence":"additional","affiliation":[{"name":"\u201dDe Gasperis\u201d Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Nava","sequence":"additional","affiliation":[{"name":"\u201dDe Gasperis\u201d Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 2011 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Pappalardo","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, 15100 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e005618","DOI":"10.1161\/CIRCOUTCOMES.119.005618","article-title":"Epidemiology of Shock in Contemporary Cardiac Intensive Care Units","volume":"12","author":"Berg","year":"2019","journal-title":"Circ. Cardiovasc. Qual. 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