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Farmakološko zdravljenje napredovalega srčnega popuščanja = Pharmacotherapeutic management of advanced heart failure
Šebeštjen, Miran
Hospital admissions for acute decompensated heart failure (ADHF) have increased precipitously during the past few decades and are projected to continue to increase in the future. To optimize patient ...outcomes and reduce the costs associated with this disorder, evidence-based pharmacotherapy is essential. The currently available parenteral vasoactive drugs for decompensated heart failure include: (1) vasodilators such as nesiritide, nitroprusside and nitroglycerin (glyceryl trinitrate); (2) catecholamine inotropes, primarily dobutamine; (3) inodilators such as milrinone, a phosphodiesterase inhibitor; (4) levosimendan. Vasodilators are most appropriate for those patients who are primarily volumeoverloaded, but with adequate peripheral perfusion. In this class of agents, nesiritide (recombinant human B-type natriuretic peptide) offers advantages over currently available drugs. Nesiritide produces rapid and sustained decreases in right atrial and pulmonary capillary wedge pressures, with reduction in pulmonary and systemic vascular resistance and increases in cardiac index. Catecholamine- and phosphodiesterase-based inotropic therapies are efficacious, but the inereased risk of arrhythmogenesis and the potential for negative survival effects limit their use. Levosimendan is a positive inotropic agent but does not increase myocyte calcium concentrations as do catecholamines or phosphodiesterase inhibitors. Clinical trial evidence demonstrates a positive survival benefit for levosimendan versus dobutamine.
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