Positief-inotrope middelen bij hartfalen

Although there are short term benefits of inotropic agents such as beta-stimulating agents and phosphodiesterase inhibitors type 3 for heart failure patients with reduced ejection fractions, their use is limited by adverse events and increased mortality. Safer inotropic agents such as omecamtiv mecarbil have been developed, that may utilize the inotropic reserve of the heart without increasing mortality. It enhances contractility by prolonging the interaction between myofilaments myosin and actin, so that the ejection time of the heart increases. The GALACTIC-HF trial (2021) demonstrated a small but significant improvement with a hazard ratio of 0.92 in the endpoint of death from cardiovascular cause or heart failure events, which in substudies appeared more relevant in advanced heart failure patients. These results, although still relevant, are now put into perspective, since the METEORIC trial (2022) failed to demonstrate a difference in VO2 max capacity in patients after 20 weeks of treatment.