Abstract
Heart failure is a worldwide leading cause of hospital admissions. There is a critical need for new methods of management in acute heart failure. The current drug panel available in the treatment of hemodinamically unstable patients is not only limited, but it is also associated with deleterious side effects. Discoveries in the heart failure field seemed to lack an adequate answer and a change in paradigm may be necessary. The cardiac myosin activator omecamtiv mecarbil is a new therapeutic approach that improves the myocardial contractility through an innovative mechanism, avoiding the harmful effects of currently used inotropic agents. Several studies provided us with promising results, but further scientific proofs are needed.
Highlights
Considerable progress has been made during the last decades in understanding, prevention and management of cardiovascular disorders (CVD), but cardiovascular-related health issues still remain the leading cause of death worldwide, accounting for almost 30% of global deaths[1,2,3]
♦ There aren’t any inotropic drugs Food and Drug Administration (FDA)-approved in the last two decades approach in chronic HFLEF is focused on neurohormonal antagonism with angiotensin enzyme inhibitors, beta-blockers and mineralocorticoid receptor antagonists, associated with preventive measures, risk factors and comorbidities management
Inotropic agents work either by augmenting calcium sensitization or by modulating the level of intracellular calcium, a process made possible through two main mechanisms: inhibition of the Na/Ca exchange pump or increasing the level of cAMP
Summary
Considerable progress has been made during the last decades in understanding, prevention and management of cardiovascular disorders (CVD), but cardiovascular-related health issues still remain the leading cause of death worldwide, accounting for almost 30% of global deaths[1,2,3]. The pathophysiological mechanisms of this condition are complex and involve various adaptive interconnected neurohormonal pathways which enter a positive feedback loop with deleterious long term effects. HF may have a preserved (HFPEF) or a low ejection fraction (HFLEF), according to the pathophysiological stage. ♦ Current inotropes have serious adverse effects trough calcium- or cAMPmediated mechanisms. ♦ There aren’t any inotropic drugs FDA-approved in the last two decades approach in chronic HFLEF is focused on neurohormonal antagonism with angiotensin enzyme inhibitors, beta-blockers and mineralocorticoid receptor antagonists, associated with preventive measures, risk factors and comorbidities management. Non surgical and surgical supportive devices play a role[4]
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