Calcium sensitizer agents: a new class of inotropic agents in the treatment of decompensated heart failure.
The clinician's primary objective in treating a patient with decompensated heart failure is rapid and effective stabilization. This goal often is achieved through the use of inotropic support. Classic inotropic agents (beta-adrenergic agonists and phosphodiesterase III inhibitors) can provide short-term hemodynamic benefits, but their long-term use has been correlated with poor survival rates. Calcium sensitizers comprise a new drug class that offers hemodynamic and symptomatic improvements without increasing cAMP and intracellular calcium concentrations. These agents enhance contractility without a concurrent increase in the risk of cardiac events and thus represent a significant improvement over classic positive inotropic agents. Levosimendan is the most potent calcium sensitizer to date, exhibiting a unique dual mechanism of action that combines a positive inotropic action mediated via calcium sensitization and a vasodilator property via ATP-dependent potassium channels. Available clinical data suggest that calcium sensitizer agents represent a promising class of inotropic agents in a field that has seen few advances in recent decades.
Perrone
Sergio V
SV
Heart Failure, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia, Instituto de Investigaciones Neurologicas Raul Carrea, FLENI, Montañeses 2325, Buenos Aires (C1428AQK), Argentina.
Kaplinsky
Edgardo J
EJ
D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002316:Cardiotonic Agents / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology; D011724:Pyridazines / Q000494:pharmacology; D000077464:Simendan
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; C041648:pimobendan