Nonglycoside inotropes in congestive heart failure. Are they beneficial or harmful?

Nonglycosidic adrenergic and nonadrenergic inotropic drugs improve systemic hemodynamics and left ventricular function in patients with severe congestive heart failure. As these beneficial effects are observed with short-term therapy, the use of these agents should be restricted to the treatment of acute heart failure. Long-term therapy with adrenergic agents as well as the phosphodiesterase inhibitors appears to enhance mortality in patients with chronic systolic heart failure. Potential indications for long-term therapy with nonglycosidic inotropic drugs include vesnarinone and ibopamine for selected patients with refractory heart failure or as pharmacologic bridges to cardiac transplantation.