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

Mitchell A. Psotka, Stephen S. Gottlieb, Gary S. Francis, Larry A. Allen, John R. Teerlink, Kirkwood F. Adams, Giuseppe M.C. Rosano, Patrizio Lancellotti

Research output: Contribution to journalReview articlepeer-review

58 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2345-2353
Number of pages9
JournalJournal of the American College of Cardiology
Issue number18
StatePublished - May 14 2019

Bibliographical note

Funding Information:
Graphic design support for the illustration was provided by Kevin Edwards at Impact Communications Partners, Inc., under the guidance and direction of the authors, and funded by Cytokinetics.

Publisher Copyright:
© 2019 The Authors


  • cardiac contractility
  • heart failure
  • inotrope
  • systolic function


Dive into the research topics of 'Cardiac Calcitropes, Myotropes, and Mitotropes: JACC Review Topic of the Week'. Together they form a unique fingerprint.

Cite this