Inotropes are the mainstay of treatment in heart failure, especially acute decompensated heart failure with reduced ejection fraction, cardiac output and organ dysfunction. They improve hemodynamics, organ perfusion and neurohumoral parameters but are often transient with increased side-effects. To provide an insight into the advantages offered by an inotrope over the other as well as its drawbacks, about 50 articles were reviewed from Elsevier, Lancet, Springer, JAMA, JAHA etc. Various heart failure trials studying the impact of inotropes on hemodynamic parameters, mortality, renal function and clinical outcomes conducted during a period between 1987- 2015 were selected. The subject population had a decreased ejection fraction or a higher NYHA (class II-IV). Various comparative trials showed that Levosimendan had better hemodynamics and renal efficacy compared to Dobutamine. However, there is an inconsistent report on effect of these drugs on mortality. In a few studies milrinone was found to be superior to Dobutamine in improving cardiac parameters, though in some Dobutamine was found to be similar to milrinone in improving cardiac index. There is a conflicting data on pros and cons of inotropes. Many studies comparing the effects of inotrope with placebo exist but those between different inotropes are a few and for a short period. For this, studies must be conducted in a larger population for a longer duration. In this review, we have assessed the current status of various inotropes including the novel agents and compared amongst their clinical outcomes, renal benefits and long-term effects on survival.
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