State-of-the-Art Paper
Inotropes

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Inotropes have been fundamental to resuscitation of acute cardiogenic shock for decades. Heart failure and cardiogenic shock, in severe cases, are syndromes characterized in many patients by a reduction in myocardial contractile force. While inotropes successfully increase cardiac output, their use has been plagued by excessive mortality due to increased tachycardia and myocardial oxygen consumption leading to arrhythmia and myocardial ischemia. There is a pressing need for new inotropic agents that avoid these harmful effects. This review describes the mechanism of action and the clinical utility of some of the older inotropic agents, which are still commonly used, and provides an update for physicians on the development of newer inotropic drugs. The field is rapidly changing, and it is likely that new agents will be designed that improve systolic performance without necessarily increasing the myocardial oxygen consumption.

Key Words

acute heart failure
cardiogenic shock
inotrope

Abbreviations and Acronyms

ATP
adenosine triphosphate
cAMP
cyclic adenosine monophosphate
LV
left ventricle
LVEDP
left ventricular end-diastolic pressure
NE
norepinephrine
PDE
phosphodiesterase
SERCA2a
sarco/endoplasmic reticulum Ca2+-ATPase
SR
sarcoplasmic reticulum

Cited by (0)

Dr. Francis serves on Data and Safety Monitoring Boards for Novartis, National Institutes of Health GUIDE-IT trial, and the ANTHEM-HF study and the executive committee for the ALL-STAR study; and is a consultant for Novartis, Amgen, Daiichi, and Denali Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.