Cardiac Calcitropes, Myotropes, and Mitotropes JACC Review Topic of the Week

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:73

Review

Psotka, Mitchell A.¹  Gottlieb, Stephen S.²  Francis, Gary S.³  Allen, Larry A.⁴  Teerlink, John R.^5,6  Adams, Kirkwood F., Jr.⁷  Rosano, Giuseppe M. G.⁸  Lancellotti, Patrizio^9,10 

[1] Inova Heart & Vasc Inst, 3300 Gallows Rd, Falls Church, VA 22042 USA

[2] Univ Maryland, Sch Med, Dept Med, Div Cardiovasc Med, Baltimore, MD 21201 USA

[3] Univ Minnesota, Div Cardiovasc, Sch Med, Minneapolis, MN 55455 USA

[4] Univ Colorado, Dept Med, Div Cardiol, Sch Med, Aurora, CO USA

[5] Univ Calif San Francisco, Sch Med, San Francisco, CA USA

[6] San Francisco VA Med Ctr, Sect Cardiol, San Francisco, CA USA

[7] Univ N Carolina, Sch Med, Chapel Hill, NC 27515 USA

[8] Univ London, St Georges Hosp NHS Trust, Cardiovasc Clin Acad Grp, London, England

[9] Univ Hosp Sart Tilman, GIGA Cardiovasc Sci, Liege, Belgium

[10] Univ Liege Hosp, Dept Cardiol, Heart Valve Clin, Liege, Belgium

关键词: cardiac contractility;    heart failure;    inotrope;    systolic function;   

DOI  :  10.1016/j.jacc.2019.02.051

来源: Elsevier

【 摘 要 】

The term inotrope is familiar and intimately connected with pharmaceuticals clinically used for treatment of low cardiac output with cardiogenic shock. Traditional inotropic agents exert their effect by modulating calcium signaling in the myocardium. Their use is associated with poor long-term outcomes. Newer molecules in development intend to break from calcium mediation and the associated detrimental long-term effects by targeting distinct mechanisms of action to improve cardiac performance. Thus, inotropy does not sufficiently describe the range of potential novel pharmaceutical products. To enhance communication around and evaluation of current, emerging, and potential therapies, this review proposes a novel nuanced and holistic framework to categorize pharmacological agents that improve myocardial performance based on 3 myocardial mechanisms: calcitropes, which alter intracellular calcium concentrations; myotropes, which affect the molecular motor and scaffolding; and mitotropes, which influence energetics. Novel chemical entities can easily be incorporated into this structure, distinguishing themselves based on their mechanisms and clinical outcomes. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

Free