Adverse Hemodynamic and Clinical Responses to Long-term Inotropic Therapy in Patients with Severe Chronic Congestive Heart Failure

  • M. Packer
Conference paper


There has been an enormous interest during the last decade in the development of positive inotropic drugs for the long-term treatment of patients with severe congestive heart failure [1]. Such agents have a particular appeal, since the primary defect in patients with heart failure is thought to be a depressed inotropic state. Some investigators have suggested, however, that the decrease in contractility seen in patients with congestive heart failure is a beneficial compensatory mechanism that permits the prolonged survival of the myocardial cell under increased loading conditions [2,3]. Hence, attempts to stimulate the failing heart pharmacologically may produce long-term detrimental effects in these patients.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Benotti JR, Grossman W, Braunwald E, Davalos DD, Alousi AA (1978) Hemodynamic assessment of amrinone: a new inotropic agent. N Engl J Med 299: 1373PubMedCrossRefGoogle Scholar
  2. 2.
    Katz AM (1973) Biochemical “defect” in the hypertrophied and failing heart. Deleterious or compensatory? Circulation 47: 1076PubMedGoogle Scholar
  3. 3.
    Katz AM (1978) A new inotropic drug: its promise and a caution. N Engl J Med 299: 1409PubMedCrossRefGoogle Scholar
  4. 4.
    Kramer BL, Masie BM, Topic N (1983) Controlled trial of captopril in chronic heart failure: a rest and exercise hemodynamic study. Circulation 67: 807PubMedCrossRefGoogle Scholar
  5. 5.
    Leier CV, Huss P, Magorien RD, Unverferth DV (1983) Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure. Circulation 67: 817PubMedCrossRefGoogle Scholar
  6. 6.
    Massie B, Bourassa M, DiBianco R, et al. (1985) Long-term oral amrinone for congestive heart failure: lack of efficacy in a multicenter controlled trial. Circulation 71: 963PubMedCrossRefGoogle Scholar
  7. 7.
    Packer M, Medina N, Yushak M (1984) Hemodynamic and clinical limitations of long-term inotropic therapy with amrinone in patients with severe chronic heart failure. Circulation 70: 1038PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • M. Packer
    • 1
  1. 1.Division of CardiologyThe Mount Sinai Medical CenterNew YorkUSA

Personalised recommendations