Campia Umberto, Nodari Savina, Gheorghiade Mihai
Center for Cardiovascular Quality and Outcomes, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 1006, Chicago, IL 60611, USA.
Curr Heart Fail Rep. 2010 Sep;7(3):100-9. doi: 10.1007/s11897-010-0021-9.
Acute heart failure represents an increasingly common cause of hospitalization, and may require the use of inotropic drugs in patients with low cardiac output and evidence of organ hypoperfusion. However, currently available therapies may have deleterious effects and increase mortality. An ideal inotropic drug should restore effective tissue perfusion by enhancing myocardial contractility without causing adverse effects. Such a drug is not available yet. New agents with different biological targets are under clinical development. In particular, istaroxime seems to dissociate the inotropic effect exerted by digitalis (inhibition of the membrane sodium/potassium adenosine triphosphatase) from the arrhythmic effect and to ameliorate diastolic dysfunction (via sarcoendoplasmic reticulum calcium adenosine triphosphatase activation). Additionally, the myosin activator omecamtiv mecarbil appears to have promising characteristics, while genetic therapy has been explored in animal studies only. Further investigations are needed to confirm and expand the effectiveness and safety of these agents in patients with acute heart failure and low cardiac output.
急性心力衰竭是住院治疗日益常见的病因，对于心输出量低且有器官灌注不足证据的患者可能需要使用正性肌力药物。然而，目前可用的治疗方法可能具有有害作用并增加死亡率。理想的正性肌力药物应通过增强心肌收缩力恢复有效的组织灌注而不产生不良反应。目前尚无此类药物。具有不同生物学靶点的新型药物正在进行临床开发。特别是，伊伐雷定似乎能将洋地黄产生的正性肌力作用（抑制膜钠/钾三磷酸腺苷酶）与心律失常作用分离，并改善舒张功能障碍（通过肌浆网钙三磷酸腺苷酶激活）。此外，肌球蛋白激活剂奥米卡替麦卡比似乎具有良好的特性，而基因治疗仅在动物研究中进行了探索。需要进一步研究以证实并扩大这些药物在急性心力衰竭和低心输出量患者中的有效性和安全性。
