Istaroxime – update of data in early cardiogenic shock and decompensated heart failure

INTRODUCTION: Cardiogenic shock (CS) is the most severe manifestation of acute heart failure (AHF), which is associated with one-year mortality rates of up to 60%. Inotropes are a cornerstone of CS treatment, as they improve central hemodynamics and provide time to address the underlying etiology. Therefore, their early administration, before CS progresses to the neurohumoral and inflammatory phase, is of great importance. Currently used inotropes are associated with adverse events, including tachycardia, ischemia, hypotension, and arrhythmias, and novel medications with a safer and more effective profile are needed. One of promising medications is istaroxime, characterized by a lower risk of malignant arrhythmias and a unique ino-lusitropic mechanism of action. AREAS COVERED: This study aimed to describe the mechanism of action of istaroxime and present results from phase II clinical trials on its effectiveness and safety in patients with early CS. EXPERT OPINION: Phase II clinical trials demonstrated that istaroxime is effective in the management of early CS (hemodynamic effect). Its advantages stem from a favorable safety profile compared with traditional inotropes, along with proven efficacy in raising systolic blood pressure (SBP) and enhancing central hemodynamics. These effects are mediated through its unique ino-lusitropic mechanism, achieved without increasing heart rate.