Current and Future Positive Inotropes to Strengthen Heart Function in Heart Failure

What is it about?

While a congestive heart failure patient will ultimately need an assist device or even a replacement heart as the disease progresses, not every patient is qualified for such advanced therapy. Such patients awaiting better circulatory support benefit from positive inotropes in the meantime as palliative care. Existing positive inotropes, for example, digoxin, dobutamine, milrinone, levosimendan, etc., are successfully marketed and in use, but exerts a lot of adverse effects like arrhythmias, hypotension, and even sudden cardiac death, thus encouraging further research on the development of novel positive inotropes. This review has investigated the molecular mechanisms of some of these adverse effects in terms of the proteins they target, followed by research on newer targets. Studies from 2013-2023 that have reported new small molecules with positive inotropic effects have been revisited in order to determine the progress made so far in drug discovery.

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Photo by Robina Weermeijer on Unsplash

Photo by Robina Weermeijer on Unsplash

Why is it important?

Globally, congestive heart failure (CHF) remains a disease of major concern with its incidences continuing to rise due to population growth and an increase in the aged population. Although HF is mostly managed by treatments that reduce congestion, hypertension, and compensatory overactivation of the sympathetic nervous system, positive inotropes are a very crucial ‘bridge-to-decision’ for end-stage HF patients. They are constantly being studied for their ability to improve cardiac hemodynamics.

Perspectives