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    Cardiac Calcitropes, Myotropes, and Mitotropes: JACC Review Topic of the Week

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    Author
    Psotka, M.A.
    Gottlieb, S.S.
    Francis, G.S.
    Date
    2019
    Journal
    Journal of the American College of Cardiology
    Publisher
    Elsevier USA
    Type
    Article
    
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    https://doi.org/10.1016/j.jacc.2019.02.051
    Abstract
    The term “inotrope” is familiar and intimately connected with pharmaceuticals clinically used for treatment of low cardiac output with cardiogenic shock. Traditional inotropic agents exert their effect by modulating calcium signaling in the myocardium. Their use is associated with poor long-term outcomes. Newer molecules in development intend to break from calcium mediation and the associated detrimental long-term effects by targeting distinct mechanisms of action to improve cardiac performance. Thus, “inotropy” does not sufficiently describe the range of potential novel pharmaceutical products. To enhance communication around and evaluation of current, emerging, and potential therapies, this review proposes a novel nuanced and holistic framework to categorize pharmacological agents that improve myocardial performance based on 3 myocardial mechanisms: calcitropes, which alter intracellular calcium concentrations; myotropes, which affect the molecular motor and scaffolding; and mitotropes, which influence energetics. Novel chemical entities can easily be incorporated into this structure, distinguishing themselves based on their mechanisms and clinical outcomes. © 2019 The Authors
    Keyword
    cardiac contractility
    heart failure
    inotrope
    systolic function
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064687087&doi=10.1016%2fj.jacc.2019.02.051&partnerID=40&md5=093c6e05e32b9dc22bbeb2224d549f66; http://hdl.handle.net/10713/10568
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jacc.2019.02.051
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