TY - JOUR
T1 - Agents with inotropic properties for the management of acute heart failure syndromes. Traditional agents and beyond
AU - Teerlink, John R.
AU - Metra, Marco
AU - Zacà, Valerio
AU - Sabbah, Hani N.
AU - Cotter, Gadi
AU - Gheorghiade, Mihai
AU - Cas, Livio Dei
PY - 2009/12
Y1 - 2009/12
N2 - Treatment with inotropic agents is one of the most controversial topics in heart failure. Initial enthusiasm, based on strong pathophysiological rationale and apparent empirical efficacy, has been progressively limited by results of controlled trials and registries showing poorer outcomes of the patients on inotropic therapy. The use of these agents remains, however, potentially indicated in a significant proportion of patients with low cardiac output, peripheral hypoperfusion and end-organ dysfunction caused by heart failure. Limitations of inotropic therapy seem to be mainly related to their mechanisms of action entailing arrhythmogenesis, peripheral vasodilation, myocardial ischemia and damage, and possibly due to their use in patients without a clear indication, rather than to the general principle of inotropic therapy itself. This review will discuss the characteristics of the patients with a potential indication for inotropic therapy, the main data from registries and controlled trials, the mechanism of the untoward effects of these agents on outcomes and, lastly, perspectives with new agents with novel mechanisms of action.
AB - Treatment with inotropic agents is one of the most controversial topics in heart failure. Initial enthusiasm, based on strong pathophysiological rationale and apparent empirical efficacy, has been progressively limited by results of controlled trials and registries showing poorer outcomes of the patients on inotropic therapy. The use of these agents remains, however, potentially indicated in a significant proportion of patients with low cardiac output, peripheral hypoperfusion and end-organ dysfunction caused by heart failure. Limitations of inotropic therapy seem to be mainly related to their mechanisms of action entailing arrhythmogenesis, peripheral vasodilation, myocardial ischemia and damage, and possibly due to their use in patients without a clear indication, rather than to the general principle of inotropic therapy itself. This review will discuss the characteristics of the patients with a potential indication for inotropic therapy, the main data from registries and controlled trials, the mechanism of the untoward effects of these agents on outcomes and, lastly, perspectives with new agents with novel mechanisms of action.
KW - Acute heart failure
KW - Advanced chronic heart failure
KW - Inotropic agents
KW - Istaroxime
KW - Omecamtiv mecarbil References :
KW - Prognosis
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U2 - 10.1007/s10741-009-9153-y
DO - 10.1007/s10741-009-9153-y
M3 - Review article
C2 - 19876734
AN - SCOPUS:70449527550
SN - 1382-4147
VL - 14
SP - 243
EP - 253
JO - Heart Failure Reviews
JF - Heart Failure Reviews
IS - 4
ER -