Zusammenfassung
Akutes Herzversagen stellt mit allein 1 Mio. Fällen/Jahr in den USA ein zentrales
medizinisches Problem dar. Während ein Teil der Patienten mit Strategien der Vor-
und Nachlastsenkung durch Diuretika und Vasodilatatoren gut rekompensiert werden kann,
stellt die Gruppe mit schwerer hämodynamischer Kompromittierung und weiter bestehender
Hypoperfusion ein besonderes Problem dar (90 Tage Mortalität: 15 %). Zur Überwindung
dieser Akutsituation wird der i. v. Einsatz von positiv inotropen Substanzen notwendig.
Derzeit stehen als Inotropika Adrenorezeptor-Agonisten (Dopamin, Dobutamin, Noradrenalin,
Adrenalin), Phosphodiesterase III Inhibitoren (Milrinon, Enoximon) und Ca2+-Sensitizer (Levosimendan) zur Verfügung. Der kurzfristigen hämodynamischen Verbesserung
der ersten beiden Gruppen steht die Steigerung des myokardialen Sauerstoffverbrauchs,
proarrhythmische Effekte und möglicherweise mittelfristig eine Exzessmortalität gegenüber.
Dieses Review beleuchtet den Stellenwert der einzelnen Substanzen im Therapiekonzept
des akuten Herzversagens und gibt einen Ausblick auf Neuentwicklungen wie Myosin-Aktivatoren
und Na+/K+-ATPase-Inhibitoren.
Abstract
Acute heart failure syndromes (AHFS) are a growing health problem in Western Countries.
Standard treatment includes vasodilators and diuretics, however, the subgroup of patients
with AHFS and low cardiac output state represents a special therapeutic challenge
that is complicated by high in-hospital and post-discharge mortality and by requiring
additional i. v. inotropic support. The current inotropes in use are adrenoreceptor
agonists (dopamine, dobutamine, norepinephrine, epinephrine), phosphodiesterase III
inhibitors (milrinone, enoximone), and Ca2+ sensitizers (levosimendane). While most inotropes yield short-term haemodynamic improvements,
they are associated with increased myocardial oxygen consumption, (supra-) ventricular
arrhythmias and possibly increased post-discharge mortality. This review highlights
current inotropes used in the treatment of AHFS and introduces new drug developments
including myosin activators and Na+/K+ ATPase inhibitors.
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Prof. Dr. med. Karl Stangl
Universitätsmedizin Berlin, Medizinische Klinik und Poliklinik mit Schwerpunkt Kardiologie
und Angiologie, Charité Campus Mitte
Charitéplatz 1
10098 Berlin
Email: karl.stangl@charite.de
