Shin David D, Brandimarte Filippo, De Luca Leonardo, Sabbah Hani N, Fonarow Gregg C, Filippatos Gerasimos, Komajda Michel, Gheorghiade Mihai
Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA, and Division of Cardiology, European Hospital, Rome, Italy.
Am J Cardiol. 2007 Jan 22;99(2A):4A-23A. doi: 10.1016/j.amjcard.2006.11.025. Epub 2006 Nov 27.
Acute heart failure syndromes (AHFS) are a major public health problem and present a therapeutic challenge to clinicians. Commonly used agents in the treatment of AHFS include diuretics, vasodilators (eg, nitroglycerin, nitroprusside, nesiritide), and inotropes (eg, dobutamine, dopamine, milrinone). Patients admitted to hospital with AHFS and low cardiac output state (AHFS/LO) represent a subgroup with very high inhospital and postdischarge mortality rates. Most of these patients require intravenous inotropic therapy. However, the use of current intravenous inotropes has been associated with risk for hypotension, atrial and ventricular arrhythmias, and possibly increased postdischarge mortality, particularly in those with coronary artery disease. Consequently, there is an unmet need for new agents to safely improve cardiac performance (contractility and/or active relaxation) in this patient population. This article reviews a selection of current and investigational agents for the treatment of AHFS, with a main focus on the high-risk patient population with AHFS/LO.
急性心力衰竭综合征（AHFS）是一个重大的公共卫生问题，给临床医生带来了治疗挑战。治疗AHFS常用的药物包括利尿剂、血管扩张剂（如硝酸甘油、硝普钠、奈西立肽）和正性肌力药物（如多巴酚丁胺、多巴胺、米力农）。因AHFS和低心排血量状态（AHFS/LO）入院的患者是住院期间和出院后死亡率极高的一个亚组。这些患者大多数需要静脉注射正性肌力药物治疗。然而，目前使用的静脉注射正性肌力药物与低血压、房性和室性心律失常风险相关，并且可能增加出院后死亡率，尤其是在患有冠状动脉疾病的患者中。因此，对于在该患者群体中安全改善心脏功能（收缩力和/或主动舒张）的新型药物存在未满足的需求。本文综述了目前用于治疗AHFS的一系列药物以及正在进行研究的药物，主要关注AHFS/LO的高危患者群体。
