Is the efficacy of positive inotropic drugs limited to symptomatic improvement?

It has been postulated that positive inotropic drugs accelerate the loss of myocardial function by increasing oxygen demands in the face of energy deficiency, especially in coronary artery disease. On the other hand subendocardial perfusion may be improved, mainly by decreasing filling pressures. Exercise tolerance, which in itself is a factor closely linked to prognosis, can be improved, and as newer compounds show, even endogenous catecholamine concentrations can be decreased. Especially the effects on peripheral vascular resistance, which many of these compounds also have, and the decrease in endogenous catecholamine concentrations might exert positive effects on mortality in congestive heart failure. The value of positive inotropic drugs in bridging therapy for heart transplantation is generally acknowledged, while the value of these compounds in chronic heart failure, especially in improvement of prognosis, has not been documented thus far.