Key result
New pharmacologic therapies for acute heart failure, including natriuretic peptides and levosimendan, are under investigation to improve short-term symptoms and long-term cardiac function.
Emerging pharmacologic therapies for acute heart failure aim to address the limitations of current treatments by targeting cellular mechanisms to improve both short-term symptoms and long-term cardiac function.
Should not yet change acute HF practice; leaves open whether natriuretic peptides or levosimendan improve outcomes in trials.
Given the limitations of high-dose diuretics and vasodilators and the increasing literature showing that inotropes, regardless of the dose used, have a detrimental effect on mortality, a variety of new agents are under investigation for the treatment of pulmonary and systemic congestion and restoration of cardiac output in the setting of acute heart failure syndromes. The new therapeutic approach is based on two goals: short-term improvement in symptoms together with long-term improvement of cardiac function. This review describes new agents that are in preclinical and in clinical phases with realistic prospects: anti-endothelin, natriuretic peptides, istaroxime, levosimendan, myosin activators, and vasopressin antagonists. Those new therapeutic strategies aim to act at the cellular level to improve vessel and heart functions, with minimal side effects, together with improved sodium and water balance.
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Tavares et al. (2008) conducted a review in Acute heart failure syndromes. New pharmacologic therapies (anti-endothelin, natriuretic peptides, istaroxime, levosimendan, myosin activators, vasopressin antagonists) was evaluated. New pharmacologic therapies for acute heart failure, including natriuretic peptides and levosimendan, are under investigation to improve short-term symptoms and long-term cardiac function.
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