{"id":"5f4548b72c3f","type":"article","url":"https://hartvaat.nl/2026/10/01/multimodaal-hemodynamisch-monitoren-richt-therapie-bij-acuut-hartfalen-en-cardio/","title":"Multimodaal hemodynamisch monitoren richt therapie bij acuut hartfalen en cardiogene shock","title_en":"Advanced hemodynamic monitoring of the patient with acute heart failure and cardiogenic shock.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Current opinion in critical care","doi":"10.1097/MCC.0000000000001420","source_url":"https://doi.org/10.1097/MCC.0000000000001420","authors":["Antonio Messina","Mathieu Jozwiak","Xavier Monnet"],"significance":5,"published":"2026-09-15","source_date":"2026-10-01","image":"https://hartvaat.nl/global/img/6e2cc0469790.webp","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/"],"congress":"","summary_en":"This narrative review outlines a physiology-driven, multimodal framework for advanced hemodynamic monitoring in acute heart failure and cardiogenic shock. Rather than relying on a single protocol, it advocates for phenotype-based assessment integrating bedside echocardiography, clinical evaluation, and targeted invasive monitoring in refractory cases. Adopting this individualized approach enables clinicians to accurately identify tissue hypoperfusion and congestion, allowing for timely, phenotype-directed therapy adjustments in a highly heterogeneous patient population.","created":"2026-09-08T01:05:14Z","updated":"2026-09-08T01:05:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narratieve review beschrijft een fysiologie-gedreven, multimodale aanpak voor hemodynamisch monitoren bij patiënten met acuut hartfalen en cardiogene shock. In plaats van één standaardprotocol benadrukt het artikel de noodzaak van fenotype-gebaseerde diagnostiek, waarbij klinisch onderzoek, kritische zorg-echocardiografie en invasieve monitoring worden gecombineerd. Deze gestructureerde benadering helpt klinici om weefselhypoperfusie en congestie nauwkeuriger te beoordelen en de therapie tijdig aan te passen, wat essentieel is voor het management van deze complexe patiëntengroep.","abstract_original":"PURPOSE OF REVIEW: To provide a practical, physiology-driven framework for advanced hemodynamic monitoring in patients with acute heart failure (AHF) and cardiogenic shock, highlighting and supporting clinicians in integrating monitoring tools into an individualized bedside approach. RECENT FINDINGS: Cardiogenic shock is increasingly recognized as a heterogeneous syndrome involving not only impaired cardiac output, but also systemic inflammation, vasoplegia, tissue hypoperfusion and multiorgan dysfunction. Recent studies have emphasized phenotype-based approaches for both diagnosis and treatment, integrating clinical evaluation, echocardiography, invasive hemodynamics and tissue perfusion markers. Machine learning derived phenotypes have further identified cardiorenal and cardiometabolic profiles associated with distinct prognostic implications. Critical care echocardiography has a central role for rapid diagnosis and serial reassessment, while transpulmonary thermodilution and pulmonary artery catheterization provide complementary information to echocardiography in refractory or complex cases. SUMMARY: Hemodynamic monitoring in AHF and cardiogenic shock should rely on individualized, multimodal and dynamic integration of clinical examination, biomarkers, echocardiography and invasive monitoring. The main goals are to define the underlying phenotype, assess congestion and tissue hypoperfusion, and evaluate treatment response. Echocardiography remains the cornerstone of bedside assessment, whereas invasive monitoring should be reserved for selected high-risk patients with persistent or complex shock."}