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J Am Coll Cardiol. 2019 May 14;73(18):2345-2353. doi: 10.1016/j.jacc.2019.02.051.

Cardiac Calcitropes, Myotropes, and Mitotropes: JACC Review Topic of the Week.

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Inova Heart and Vascular Institute, Falls Church, Virginia. Electronic address:
Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
School of Medicine, University of California San Francisco and Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California.
University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Cardiovascular Clinical Academic Group, St. George's Hospitals NHS Trust University of London, London, United Kingdom.
GIGA Cardiovascular Sciences, University Hospital Sart Tilman, and Departments of Cardiology, Heart Valve Clinic, University of Liege Hospital, Liege, Belgium.


The term "inotrope" is familiar and intimately connected with pharmaceuticals clinically used for treatment of low cardiac output with cardiogenic shock. Traditional inotropic agents exert their effect by modulating calcium signaling in the myocardium. Their use is associated with poor long-term outcomes. Newer molecules in development intend to break from calcium mediation and the associated detrimental long-term effects by targeting distinct mechanisms of action to improve cardiac performance. Thus, "inotropy" does not sufficiently describe the range of potential novel pharmaceutical products. To enhance communication around and evaluation of current, emerging, and potential therapies, this review proposes a novel nuanced and holistic framework to categorize pharmacological agents that improve myocardial performance based on 3 myocardial mechanisms: calcitropes, which alter intracellular calcium concentrations; myotropes, which affect the molecular motor and scaffolding; and mitotropes, which influence energetics. Novel chemical entities can easily be incorporated into this structure, distinguishing themselves based on their mechanisms and clinical outcomes.


cardiac contractility; heart failure; inotrope; systolic function

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