Gustafsson Finn, Damman Kevin, Nalbantgil Sanem, Van Laake Linda W, Tops Laurens F, Thum Thomas, Adamopoulos Stamatis, Bonios Michael, Coats Andrew Js, Crespo-Leiro Maria G, Mehra Mandeep R, Filippatos Gerasimos, Hill Loreena, Metra Marco, Jankowska Ewa, de Jonge Nicolaas, Kaye David, Masetti Marco, Parissis John, Milicic Davor, Seferovic Petar, Rosano Giuseppe, Ben Gal Tuvia
Department of Cardiology, Rigshospitalet, University of Copenhagen, København, Denmark.
University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Heart Fail. 2023 Apr;25(4):457-468. doi: 10.1002/ejhf.2814. Epub 2023 Mar 10.
This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline-directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end-of-life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support).
本临床共识声明回顾了晚期心力衰竭患者使用正性肌力支持的情况。当前指南仅支持在急性失代偿性心力衰竭且有器官灌注不良或休克证据的情况下使用正性肌力药物。然而，对于其他无急性严重失代偿的晚期心力衰竭患者，使用正性肌力支持可能是合理的。本文回顾了支持在这些情况下使用正性肌力药物的临床证据。特别讨论了持续充血、全身灌注不足或需要姑息治疗的晚期心力衰竭患者，以及与植入左心室辅助装置或心脏移植相关的特定情况。讨论了具有正性肌力作用的传统和新型药物，并回顾了正性肌力支持期间指南指导治疗的使用情况。最后，描述了家庭正性肌力治疗，并就持续正性肌力支持的管理（包括慢性正性肌力治疗支持的维持和撤机指导）回顾了姑息治疗和临终关怀方面。
