Inotropes and inodilators for acute heart failure: sarcomere active drugs in focus.
Acute heart failure (AHF) emerges as a major and growing epidemiological concern with high morbidity and mortality rates. Current therapies in patients with acute heart failure rely on different strategies. Patients with hypotension, hypoperfusion, or shock require inotropic support, whereas diuretics and vasodilators are recommended in patients with systemic or pulmonary congestion. Traditionally inotropic agents, referred to as Ca mobilizers load the cardiomyocyte with Ca and thereby increase oxygen consumption and risk for arrhythmias. These limitations of traditional inotropes may be avoided by sarcomere targeted agents. Direct activation of the cardiac sarcomere may be achieved by either sensitizing the cardiac myofilaments to Ca or activating directly the cardiac myosin. In this review, we focus on sarcomere targeted inotropic agents, emphasizing their mechanisms of action and overview the most relevant clinical considerations.
*Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; and †Critical Care, Proprietary Products Division, Orion Pharma, Orion Corporation, Espoo, Finland.
László
L
Nagy
Piero
P
Pollesello
Zoltán
Z
Papp
D000208:Acute Disease; D000818:Animals; D002118:Calcium / Q000378:metabolism; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000494:pharmacology*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D058990:Molecular Targeted Therapy; D032383:Myocytes, Cardiac / Q000378:metabolism; D010101:Oxygen Consumption / Q000502:physiology; D012518:Sarcomeres / Q000378:metabolism*; D014665:Vasodilator Agents / Q000009:adverse effects / Q000494:pharmacology
D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D002118:Calcium