Agents with inotropic properties for the management of acute  heart failure syndromes. Traditional agents and beyond.
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.
Teerlink
John R
JR
San Francisco Veterans Affairs Medical Center, University of California, USA.
Metra
Marco
M
Zacà
Valerio
V
Sabbah
Hani N
HN
Cotter
Gadi
G
Gheorghiade
Mihai
M
Cas
Livio Dei
LD
D000208:Acute Disease; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004077:Digoxin / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D004280:Dobutamine / Q000008:administration & dosage; D005043:Etiocholanolone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D005080:Exercise Test; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006770:Hospitals, Group Practice; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis; D011719:Pyrazines; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use; D011804:Quinolines / Q000008:administration & dosage; D053498:Sarcoplasmic Reticulum Calcium-Transporting ATPases / Q000187:drug effects; D000077464:Simendan; D016896:Treatment Outcome; D014508:Urea / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D002316:Cardiotonic Agents; D006835:Hydrazones; D011719:Pyrazines; D011724:Pyridazines; D011804:Quinolines; D014665:Vasodilator Agents; C547293:omecamtiv mecarbil; D000077464:Simendan; D004280:Dobutamine; C041667:vesnarinone; D004077:Digoxin; D014508:Urea; D005043:Etiocholanolone; D053498:Sarcoplasmic Reticulum Calcium-Transporting ATPases; C468128:Istaroxime