title: [Treatment of heart failure patients with inotropic drugs: beyond traditional agents].
abstract: Hospitalizations for acute heart failure are associated with high mortality and readmission rates. Ten to 20% of the patients have signs of low cardiac output and fluid overload. The administration of inotropic agents to correct these hemodynamic abnormalities may be indicated in these patients. However, the risk to benefit ratio of inotropic agents is high and an increase of untoward effects and mortality has been suggested by many retrospective analyses and meta-analyses. Limitations of inotropic therapy seem mainly related to their mechanisms of action based, in the case of the traditional agents, on an increase in intracellular cyclic AMP and calcium concentrations. Concomitant peripheral vasodilation, such as in the case of the novel agent levosimendan is another important limitation, above when patients are hypotensive and/or treated with vasodilators and high doses of diuretics. Myosin activators, histaroxime, sarcoplasmic reticulum ATPase activators and metabolic agents seem promising as active through different mechanisms than traditional agents and, in many cases, not associated with tachycardia or hypotension. Further studies are, however, needed.
authors.affiliation: Cardiologia, Dipartimento di Medicina Sperimentale ed Applicata, Università degli Studi, Spedali Civili, Brescia. metramarco@libero.it
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Valentina
authors.initials: V
authors.lastname: Carubelli
authors.forename: Luca
authors.initials: L
authors.lastname: Bettari
authors.forename: Silvia
authors.initials: S
authors.lastname: Bugatti
authors.forename: Rossella
authors.initials: R
authors.lastname: Danesi
authors.forename: Valentina
authors.initials: V
authors.lastname: Lazzarini
authors.forename: Alice
authors.initials: A
authors.lastname: Monti
authors.forename: Clara
authors.initials: C
authors.lastname: Villa
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D058665:Adrenergic beta-1 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use; D017408:Guidelines as Topic; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D000077464:Simendan
chemical_list: D058665:Adrenergic beta-1 Receptor Agonists; D002316:Cardiotonic Agents; D006835:Hydrazones; D010726:Phosphodiesterase Inhibitors; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine