Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice

Bistola, Vasiliki; Arfaras-Melainis, Angelos; Polyzogopoulou, Eftihia; Ikonomidis, Ignatios; Parissis, John

doi:10.15420/cfr.2019.11.2

Cited by 49 publications

(37 citation statements)

References 61 publications

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“…В настоящее время клиническая медицина не располагает универсальными инотропными и вазоактивными препаратами, которые оказались бы более эффективными в отношении улучшения прогноза пациента по сравнению с добутамином или норадреналином [8,9]. Имеются отдельные клинические исследования, свидетельствующие о том, что левосимендан в сравнении с добутамином может оказаться более эффективным в отношении влияния на маркеры почечной и печеночной дисфункции без значимого положительного влияния на конечные точки [7,10].…”

Section: Discussionunclassified

Leading predictors of early and late hospital mortality among patients with acute decompensated heart failure and ways to improve prognosis

Поляков

Фомин

Vinogradova

et al. 2021

jour

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Objective: to analyze the leading causes of early (first two days) and late (after the second day) hospital mortality among of patients with acute decompensated heart failure.Materials and methods: a retrospective single-center cohort (n=718) of patients with acute decompensated heart failure.Results: predictors of prognosis for early hospital mortality were pulmonary edema, hepatomegaly, the need for inotropic and vasopressive drugs, the level of systolic blood pressure and creatinine. Predictors of prognosis for late hospital mortality were pulmonary edema, the need for inotropic drugs, community-acquired pneumonia, and laboratory markers of acute renal injury.Conclusion: Tactical approaches are proposed to reduce hospital mortality of patients with acute decompensated heart failure.

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Section: Discussionunclassified

Leading predictors of early and late hospital mortality among patients with acute decompensated heart failure and ways to improve prognosis

Поляков

Фомин

Vinogradova

et al. 2021

jour

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“…These observations may be usefully contextualised into a ‘right patient, right drug’ schema that can be used to guide vasoactive and/or inotropic therapy ( Table 3 ). [ 105 ] The first phase of this schema examines whether or not an inotrope is needed at all and includes exclusion of otherwise treatable causes or the availability of viable alternatives. The next step is to identify the most suitable inotrope; levosimendan figures prominently in several categories, including cardiogenic shock, cardiac surgery and right ventricular failure.…”

Section: Levosimendan In Current Usementioning

confidence: 99%

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use

Papp¹,

Agostoni²,

Álvarez³

et al. 2020

Cardiac Failure Review

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Levosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Levosimendan is currently in active clinical evaluation in the US. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and non-cardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute heart failure arena in recent times and charts a possible development trajectory for the next 20 years.

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“…Application of standard therapies for ADHF and shock may be ineffective or even harmful in certain SHD emergencies (Table 3). 16,17 Specifically, the increased heart rate (HR) or afterload resulting from inotropes or vasopressors can paradoxically worsen hemodynamics in specific SHD emergencies. The intra-aortic balloon pump (IABP) remains controversial for patients with CS due to AMI but is a standard part of management for selected SHD emergencies and contraindicated in others (Table 3); the same is true for other percutaneous MCS devices including extracorporeal membrane oxygenation (ECMO).…”

Section: General Considerationsmentioning

confidence: 99%

Structural Heart Disease Emergencies

Jentzer

Ternus

Eleid

et al. 2020

J Intensive Care Med

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Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.

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Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice

Cited by 49 publications

References 61 publications

Leading predictors of early and late hospital mortality among patients with acute decompensated heart failure and ways to improve prognosis

Leading predictors of early and late hospital mortality among patients with acute decompensated heart failure and ways to improve prognosis

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use

Structural Heart Disease Emergencies

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