Search for better inotropic drugs should continue

BMJ 1998;317:476 ( 15 August )

Letters

Search for better inotropic drugs should continue

The first 150 words of the full text of this article appear below.

EDITOR $---$ In their editorial on drug treatment in heart failure, Steeds and Channer state that "all clinical trials of positivelyinotropic drugs have either failed to improve symptoms or haveincreased mortality in heart failure."¹ Even if this statementis allowed, it is a generalisation too far to conclude that "drugsthat increase the force of contraction of the failing heart resultin increased mortality and...there should be a halt on furtherdevelopment in this direction."

We believe that there are at least two reasons why attempts to develop better inotropic drugs should continue. Firstly, basicstudies of heart muscle over the past two decades have shown thatthere are two cellular routes to improving the strength of theheart: (a) increasing intracellular calcium concentrations and(b) increasing myofilament calcium sensitivity, resulting in strongercontractions for a given amount of calcium.² All clinicallytested drugs . . . [Full text of this article]