Section Review: Cardiovascular & Renal: Calcium sensitisers and heart failure

To date, the use of positive inotropic agents for the treatment of heart failure has not been a success. Not only have these drugs had little documentable beneficial effect on survival, but in some instances, most notably with the phosphodiesterase inhibitors, they have-caused an unacceptable increase in early mortality due to arrhythmias [1]. This has led to a body of opinion in some quarters that positive inotropic therapy for heart failure is a doomed approach and that all efforts should be concentrated on preventing or reversing atheroma, enhancing blood flow to the myocardium and dealing with the effects of secondary compensatory mechanisms. Although everyone agrees that prevention is better than cure, it seems inevitable that there will always be substantial numbers of patients with heart failure of various degrees of severity. Thus, it is important to be very sure of the facts before abandoning any hope of pharmacological contractile support for these patients. This article briefly reviews current evidence on the potential utility of calcium sensitisers.