Heart Failure Reviews

, Volume 14, Issue 4, pp 243-253

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Agents with inotropic properties for the management of acute heart failure syndromes. Traditional agents and beyond

  • John R. TeerlinkAffiliated withSection of Cardiology, San Francisco Veterans Affairs Medical Center, University of California, San Francisco
  • , Marco MetraAffiliated withCardiology, Department of Experimental and Applied Medicine, University of Brescia Email author 
  • , Valerio ZacàAffiliated withDivision of Cardiology, Cardiovascular and Thoracic Department, Santa Maria alle Scotte Hospital
  • , Hani N. SabbahAffiliated withDepartment of Medicine, Division of Cardiovascular Medicine, Henry Ford Heart & Vascular Institute
  • , Gadi CotterAffiliated withMomentum Research
  • , Mihai GheorghiadeAffiliated withFeinberg School of Medicine, Northwestern University
  • , Livio Dei CasAffiliated withCardiology, Department of Experimental and Applied Medicine, University of Brescia


Treatment with inotropic agents is one of the most controversial topics in heart failure. Initial enthusiasm, based on strong pathophysiological rationale and apparent empirical efficacy, has been progressively limited by results of controlled trials and registries showing poorer outcomes of the patients on inotropic therapy. The use of these agents remains, however, potentially indicated in a significant proportion of patients with low cardiac output, peripheral hypoperfusion and end-organ dysfunction caused by heart failure. Limitations of inotropic therapy seem to be mainly related to their mechanisms of action entailing arrhythmogenesis, peripheral vasodilation, myocardial ischemia and damage, and possibly due to their use in patients without a clear indication, rather than to the general principle of inotropic therapy itself. This review will discuss the characteristics of the patients with a potential indication for inotropic therapy, the main data from registries and controlled trials, the mechanism of the untoward effects of these agents on outcomes and, lastly, perspectives with new agents with novel mechanisms of action.


Acute heart failure Advanced chronic heart failure Inotropic agents Prognosis Istaroxime Omecamtiv mecarbil