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Published in: Heart Failure Reviews 4/2009

Open Access 01-12-2009

Agents with inotropic properties for the management of acute heart failure syndromes. Traditional agents and beyond

Authors: John R. Teerlink, Marco Metra, Valerio Zacà, Hani N. Sabbah, Gadi Cotter, Mihai Gheorghiade, Livio Dei Cas

Published in: Heart Failure Reviews | Issue 4/2009

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Abstract

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.
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Metadata
Title
Agents with inotropic properties for the management of acute heart failure syndromes. Traditional agents and beyond
Authors
John R. Teerlink
Marco Metra
Valerio Zacà
Hani N. Sabbah
Gadi Cotter
Mihai Gheorghiade
Livio Dei Cas
Publication date
01-12-2009
Publisher
Springer US
Published in
Heart Failure Reviews / Issue 4/2009
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI
https://doi.org/10.1007/s10741-009-9153-y

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