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Int. J. Mol. Sci. 2015, 16(12), 29060-29068; doi:10.3390/ijms161226147

Use of Inotropic Agents in Treatment of Systolic Heart Failure

Cardiology Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, NY 10595, USA
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Author to whom correspondence should be addressed.
Academic Editor: H. W. M. Niessen
Received: 5 October 2015 / Revised: 22 November 2015 / Accepted: 25 November 2015 / Published: 4 December 2015
(This article belongs to the Special Issue Improvement of Cardiac Function in Heart Failure)
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Abstract

The most common use of inotropes is among hospitalized patients with acute decompensated heart failure, with reduced left ventricular ejection fraction and with signs of end-organ dysfunction in the setting of a low cardiac output. Inotropes can be used in patients with severe systolic heart failure awaiting heart transplant to maintain hemodynamic stability or as a bridge to decision. In cases where patients are unable to be weaned off inotropes, these agents can be used until a definite or escalated supportive therapy is planned, which can include coronary revascularization or mechanical circulatory support (intra-aortic balloon pump, extracorporeal membrane oxygenation, impella, left ventricular assist device, etc.). Use of inotropic drugs is associated with risks and adverse events. This review will discuss the use of the inotropes digoxin, dopamine, dobutamine, norepinephrine, milrinone, levosimendan, and omecamtiv mecarbil. Long-term inotropic therapy should be offered in selected patients. A detailed conversation with the patient and family shall be held, including a discussion on the risks and benefits of use of inotropes. Chronic heart failure patients awaiting heart transplants are candidates for intravenous inotropic support until the donor heart becomes available. This helps to maintain hemodynamic stability and keep the fluid status and pulmonary pressures optimized prior to the surgery. On the other hand, in patients with severe heart failure who are not candidates for advanced heart failure therapies, such as transplant and mechanical circulatory support, inotropic agents can be used for palliative therapy. Inotropes can help reduce frequency of hospitalizations and improve symptoms in these patients. View Full-Text
Keywords: inotropes; digoxin; dopamine; dobutamine; norepinephrine; milrinone; levosimendan; omecamtiv mecarbil inotropes; digoxin; dopamine; dobutamine; norepinephrine; milrinone; levosimendan; omecamtiv mecarbil
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Tariq, S.; Aronow, W.S. Use of Inotropic Agents in Treatment of Systolic Heart Failure. Int. J. Mol. Sci. 2015, 16, 29060-29068.

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