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(Circulation. 2003;108:367.)
© 2003 American Heart Association, Inc.

Cardiovascular Drugs

Clinical Use of Inotropic Therapy for Heart Failure: Looking Backward or Forward? Part I: Inotropic Infusions During Hospitalization

Lynne Warner Stevenson, MD

From the Division of Cardiology, Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Lynne Warner Stevenson, MD, Division of Cardiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115.

Key Words: heart failure • cardiomyopathy • hemodynamics

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Early descriptions of heart failure focused on the syndrome of congestion, an excess of the wet or melancholic humors, "dropsy," or "backward" failure.¹ Although associations with weak pulses and cool skin were also noted, more precise measurement of impaired contraction at the level of the heart and the myocyte itself later redefined heart failure as a malady of impaired forward function. Focus on forward failure was sharpened by dramatic initial responses to agents that stimulate contractility. However, the inability to sustain early improvements with inotropic agents was accompanied by increased mortality.^2,3 Focusing instead on chronic responses, inhibition of the renin-angiotensin system and peripheral blockade of ß-adrenergic receptors have been found over time to help preserve and in some cases improve contractility, decrease filling pressures, and prolong survival.^4–6 These neurohormonal antagonists decrease the development and worsening of heart failure. In trial populations dominated by mild-moderate heart failure, the majority of patients with left ventricular dysfunction have preserved cardiac output at rest and are limited primarily by impaired volume regulation and diminished cardiac output responses to exercise. Despite the benefits of interventions for mild-moderate heart failure, it has remained a progressive disease. In the later stages of heart failure that lead to repeated hospitalization, resting flow decreases to vital organs, particularly the kidney. Inotropic therapy is frequently considered in hopes that either brief or prolonged stimulation of contractility to increase perfusion may help to restore compensation for a period of time.

The decision to use inotropic therapy and the selection of inotropic . . . [Full Text of this Article]

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