Department of Internal Medicine, University of Florida, Gainesville, FL, USA.
Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
Heart Fail Rev. 2021 Mar;26(2):355-361. doi: 10.1007/s10741-020-10029-x. Epub 2020 Sep 30.
Intravenous inotropic therapy can be used in patients with advanced heart failure, as palliative therapy or as a bridge to cardiac transplantation or mechanical circulatory support, as well as in cardiogenic shock. Their use is limited to increasing cardiac output in low cardiac output states and reducing ventricular filling pressures to alleviate patient symptoms and improve functional class. Many advanced heart failure patients have sinus tachycardia as a compensatory mechanism to maintain cardiac output. However, excessive sinus tachycardia caused by intravenous inotropes can increase myocardial oxygen consumption, decrease coronary perfusion, and at extreme heart rates decrease ventricular filling and stroke volume. The limited available hemodynamic studies support the hypothesis that adding ivabradine, a rate control agent without negative inotropic effect, may blunt inotrope-induced tachycardia and its associated deleterious effects, while optimizing cardiac output by increasing stroke volume. This review analyzes the intriguing pathophysiology of combined intravenous inotropes and ivabradine to optimize the hemodynamic profile of patients in advanced heart failure. Graphical abstract Illustration of the beneficial and deleterious hemodynamic effects of intravenous inotropes in advanced heart failure, and the positive effects of adding ivabradine.
静脉内正性肌力治疗可用于晚期心力衰竭患者，作为姑息治疗或作为心脏移植或机械循环支持的桥梁，也可用于心源性休克。其用途仅限于增加低心输出状态下的心输出量，并降低心室充盈压，以缓解患者症状并改善功能分级。许多晚期心力衰竭患者存在窦性心动过速作为维持心输出量的代偿机制。然而，静脉内正性肌力药物引起的过度窦性心动过速会增加心肌耗氧量、降低冠状动脉灌注，在极端心率下会降低心室充盈和每搏量。有限的可用血流动力学研究支持这样一种假设，即添加无负性肌力作用的伊伐布雷定（一种控制心率的药物）可能会减弱正性肌力药物引起的心动过速及其相关的有害作用，同时通过增加每搏量来优化心输出量。这篇综述分析了联合使用静脉内正性肌力药物和伊伐布雷定以优化晚期心力衰竭患者血流动力学特征的迷人病理生理学。
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