Reduced systolic function is central to the pathophysiology and clinical sequelae of acute decompensated heart failure (ADHF) with reduced ejection fraction and cardiogenic shock. These clinical entities are the final common pathway for marked deterioration of right or left ventricular function and can occur in multiple clinical presentations including severe ADHF, myocardial infarction, post-cardiac surgery, severe pulmonary hypertension, and advanced or end-stage chronic heart failure. Inotropic therapies improve ventricular systolic function and may be divided into three classes on the basis of their mechanism of action (calcitropes, mitotropes, and myotropes). Most currently available therapies for cardiogenic shock are calcitropes which can provide critical haemodynamic support, but also may increase myocardial oxygen demand, ischaemia, arrhythmia, and mortality. Emerging therapies to improve cardiac function such as mitotropes (e.g. perhexiline, SGLT2i) or myotropes (e.g. omecamtiv mecarbil) may provide useful alternatives in the future.

中文翻译：

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心力衰竭和心源性休克的正性肌力疗法：教育回顾

收缩功能降低是急性失代偿性心力衰竭 (ADHF) 的病理生理学和临床后遗症的核心，伴有射血分数降低和心源性休克。这些临床实体是右心室或左心室功能显着恶化的最终共同途径，可发生在多种临床表现中，包括严重 ADHF、心肌梗死、心脏手术后、严重肺动脉高压以及晚期或终末期慢性心力衰竭。正性肌力疗法可改善心室收缩功能，并可根据其作用机制分为三类（降钙素、有丝分裂素和肌力素）。目前用于心源性休克的大多数可用疗法是骨钙素，它可以提供关键的血流动力学支持，但也可能增加心肌需氧量、缺血、心律失常和死亡率。改善心脏功能的新兴疗法，如促肌药（例如 perhexiline，SGLT2i）或肌药（例如 omecamtiv mecarbil）可能会在未来提供有用的替代方案。