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Clinical Importance of Phosphodiesterase 3 Inhibitors on Outcomes in Patients With Cardiogenic Shock　- A Systematic

Masahiro Yamamoto1, Yumiko Hosoya2, Hiroyuki Hanada3

  • 1Department of Cardiovascular Medicine, Kumamoto University Kumamoto Japan.

Circulation Reports
|November 11, 2025
PubMed

Insights

Phosphodiesterase 3 inhibitors (PDE3i) show no significant difference in outcomes for cardiogenic shock (CS) patients compared to other inotropes. Early deaths, cardiac arrest, and renal replacement therapy initiation were similar across treatments.

Area of Science:

  • Cardiology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Inotropes are crucial for managing cardiogenic shock (CS).
  • Phosphodiesterase 3 inhibitors (PDE3i) are increasingly used in CS despite limited evidence.
  • The clinical importance of PDE3i in CS requires further investigation.

Purpose of the Study:

  • To systematically review the clinical effectiveness of PDE3i in patients with cardiogenic shock.
  • To compare outcomes of PDE3i (with or without other inotropes) versus no PDE3i in CS.
  • To assess early death, cardiac arrest, and renal replacement therapy initiation as key outcomes.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs).
  • Searched PubMed, Web of Science, and CENTRAL databases up to October 31, 2024.
  • Included 2 RCTs with 224 patients comparing PDE3i (milrinone, enoximone) with other inotropes (dobutamine, levosimendan).

Main Results:

  • Meta-analysis of 2 RCTs found no significant difference in early deaths (OR 1.47, 95% CI 0.35-6.26).
  • No significant difference was observed for cardiac arrest (OR 1.14, 95% CI 0.42-3.14).
  • Initiation of renal replacement therapy also showed no significant difference (OR 1.53, 95% CI 0.80-2.92).

Conclusions:

  • This systematic review found no difference in outcomes for cardiogenic shock patients treated with PDE3i.
  • Early deaths, cardiac arrest, and renal replacement therapy initiation were comparable between PDE3i and other inotropes.
  • The use of PDE3i in CS does not appear to alter key clinical outcomes based on current evidence.
Abstract

Keywords:
Cardiogenic shockInotropesPDE3iPhosphodiesterase 3 inhibitorsSystematic review

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