Energetic stimulation of the heart

The management of patients with acute heart failure includes frequently the use of positive inotropic agents in order to increase cardiac output and hence to maintain adequate tissue perfusion. The concept of energetic stimulation of the heart was invented in order to avoid deleterious effects of conventional inotropes, i.e. catecholamines and phosphodiesterase-inhibitors, on myocardial oxygen consumption and energy reserves and to circumvent potential dangerous side effects of the drugs. Metabolic support with glucose-insulin-potassium has proven efficious of improving cardiac performance and prognosis in the setting of the ischemic and postischemic heart. The glycolytic intermediate pyruvate increases contractile performance in isolated animal and human myocardium and improves short-time hemodynamics in patients with congestive heart failure, which is discussed in detail in the present article. Energetic stimulation with pyruvate could therefore be a new promising approach to the treatment of acute heart failure, if conventional therapy fails.