The role of calcitropes in treating HFrEF
Calcitropes are a class of traditional inotropes that are generally reserved for advanced heart failure as treatment for cardiogenic shock, bridge to LVAD or transplant, or as palliative therapy because long-term use is associated with increased mortality in patients with heart failure with reduced ejection fraction (HFrEF).7
- With continued use, calcitropes detrimentally alter myocardial energetics, decrease the ATP/ADP ratio, and have been associated with poor clinical outcomes, including malignant arrhythmias7
The promise of myotropes and mitotropes
In contrast to calcitropes, myotropes and mitotropes may improve long-term myocardial contractility and mortality without increasing cardiomyocyte calcium fluxes.7
- Mitotropes target the energy dependence of myocardial contraction and the metabolic deficiencies present in the myocardium of patients with HFrEF7
- Myotropes target the sarcomere’s contractility via myosin, actin, and associated regulatory proteins through calcium-independent mechanisms7