Inotropes and vasopressors in acute heart failure, when the devil dresses as an angel

Mortara, Andrea

doi:10.1002/ejhf.1037

Cited by 2 publications

(2 citation statements)

References 11 publications

(23 reference statements)

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“…Thus, the observed association with heightened mortality may be merely coincidental. This dilemma underscores one of the most intricate challenges in deciphering the potential cause-and-effect relationship between these pharmaceutical interventions and clinical outcomes [11].…”

Section: Exploring the Evidence Through Trials And Registry: An Issue...mentioning

confidence: 99%

Inotropic Agents: Are We Still in the Middle of Nowhere?

Iorio,

Lucà,

Pozzi

et al. 2024

JCM

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Inotropes are prescribed to enhance myocardial contractility while vasopressors serve to improve vascular tone. Although these medications remain a life-saving therapy in cardiovascular clinical scenarios with hemodynamic impairment, the paucity of evidence on these drugs makes the choice of the most appropriate vasoactive agent challenging. As such, deep knowledge of their pharmacological and hemodynamic effects becomes crucial to optimizing hemodynamic profile while reducing the potential adverse effects. Given this perspective, it is imperative for cardiologists to possess a comprehensive understanding of the underlying mechanisms governing these agents and to discern optimal strategies for their application across diverse clinical contexts. Thus, we briefly review these agents’ pharmacological and hemodynamic properties and their reasonable clinical applications in cardiovascular settings. Critical interpretation of available data and the opportunities for future investigations are also highlighted.

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Section: Exploring the Evidence Through Trials And Registry: An Issue...mentioning

confidence: 99%

Inotropic Agents: Are We Still in the Middle of Nowhere?

Iorio,

Lucà,

Pozzi

et al. 2024

JCM

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“…inotropes or had relapsed after such treatment. At the treating physician's discretion and taking into account adverse effects the inotropes have on long-term outcomes 14,15 , most patients were not treated with inotropes before mirabegron was prescribed.…”

Section: Patientsmentioning

confidence: 99%

Targeting cardiac myocyte Na⁺-K⁺ pump function with β3 adrenergic agonist in rabbits and patients with severe congestive heart failure

Fry

Liu

García

et al. 2019

Preprint

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RationaleA high cytosolic Na + concentration ([Na + i]) impairs contractility of myocardium from patients with advanced heart failure (HF) and since the Na + -K + pump maintains a low [Na + i], targeting pump function might be beneficial. Objective Determine if cardiac myocyte Na + -K + pump function is impaired in rabbits with severe congestive HF and whether in vivo treatment with β3 adrenoceptor (β3 AR) agonists, that are known to stimulate the pump in vitro, reverses the HF syndrome. Assess the clinical response when patients with advanced treatment-resistant HF are prescribed a β3 AR agonist. Methods and ResultsCoronary ligation caused marked organ congestion and ascites in rabbits. Na + -K + pump current of myocytes from non-infarcted myocardium was decreased. This was reversed by β3 AR agonist treatment that also significantly reduced organ congestion and prevalence of ascites. Animal models cannot examine if efficacy is additive to guideline-directed drugs up-titrated to maximal tolerated doses. We studied outcomes of 9 patients hospitalized with advanced HF (stage D) refractory to maximally tolerated treatment as assessed by ≥ 2 cardiologists. One-year mortality of such patients is 75% with medical treatment and almost all die within 2 years, 90% from HF. The off-label oral treatment with the β3 AR agonist mirabegron rapidly improved signs and symptoms on a time scale similar to that of the rabbits. Improvement of ≥1 NYHA Class was maintained early post-discharge with continued treatment. One patient died from HF at 16 months, 4 died from other causes at 2 -30 months and 4 remain alive at 32 ± 5 months with NYHA Class II symptoms. ConclusionsParallel treatment-induced reversal of Na + -K + pump inhibition and features of HF in rabbits provides mechanistic rationale for efficacy of β3 AR agonists. Improved in-hospital clinical trajectory and more favourable post-discharge course than expected suggest efficacy of mirabegron in advanced human HF.

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Inotropes and vasopressors in acute heart failure, when the devil dresses as an angel

Cited by 2 publications

References 11 publications

Inotropic Agents: Are We Still in the Middle of Nowhere?

Inotropic Agents: Are We Still in the Middle of Nowhere?

Targeting cardiac myocyte Na⁺-K⁺ pump function with β3 adrenergic agonist in rabbits and patients with severe congestive heart failure

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Inotropes and vasopressors in acute heart failure, when the devil dresses as an angel

Cited by 2 publications

References 11 publications

Inotropic Agents: Are We Still in the Middle of Nowhere?

Inotropic Agents: Are We Still in the Middle of Nowhere?

Targeting cardiac myocyte Na+-K+ pump function with β3 adrenergic agonist in rabbits and patients with severe congestive heart failure

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Product

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About

Targeting cardiac myocyte Na⁺-K⁺ pump function with β3 adrenergic agonist in rabbits and patients with severe congestive heart failure