Aging Clinical and Experimental Research

, Volume 8, Issue 2, pp 90–98

Inotropic agents in older patients with chronic heart failure — Current perspectives

Authors

  • P. U. Carbonin
    • Cattedra di GerontologiaUniversità Cattolica del S. Cuore
  • G. Zuccalà
    • Cattedra di GerontologiaUniversità Cattolica del S. Cuore
Review Article

DOI: 10.1007/BF03339561

Cite this article as:
Carbonin, P.U. & Zuccalà, G. Aging Clin Exp Res (1996) 8: 90. doi:10.1007/BF03339561

Abstract

Until recently, inotropic therapy has been regarded as the most direct remedy for the left ventricular systolic dysfunction that often underlies the development of heart failure. Nevertheless, all the agents with significant inotropic properties that have been evaluated to date (such as beta adrenergic stimulants, phosphodiesterase inhibitors, and high-dose vesnarinone) showed significant increases in mortality with long-term administration. However, it is noteworthy that the participants in trials to evaluate inotropic therapy were not representative of geriatric heart failure patients for age, gender, and comorbidity. Thus, results from these studies must be interpreted cautiously when treatment for chronic heart failure must be applied to elderly subjects. At present, digitalis is the only inotropic agent recommended for long-term treatment, because it improves symptoms and prevents disease progression through neurohormonal and baroreceptor mechanisms; nevertheless, its long-term safety is still undetermined. The role of low-dose vesnarinone, pimobendan and ibopamine, which share neurohormonal, rather than inotropic, mechanisms of action, is still under investigation. Pending the definition of these issues, ACE-inhibitors and diuretics remain the mainstay of therapy for chronic heart failure.

Key words

Digitalis therapy heart failure inotropic agents left ventricular function

Copyright information

© Springer Internal Publishing Switzerland 1996