ABC Heart Fail Cardiomyop 2022; 2(1): 50-54
New Drugs for Treatment of Heart Failure with Reduced Ejection Fraction: Vericiguat and Omecamtiv Mecarbil
Mucio Tavares de Oliveira Jr
, Antonio Carlos Pereira Barretto
, Carlos Henrique Del Carlo
, Sergio Jallad
, Mariana Silveira de Alcantara Chaud
Omecamtiv mecarbil – myosin activator
During the 1980s and 1990s, several attempts at long-term treatment with inotropes in patients with systolic dysfunction almost always resulted in increased mortality or a neutral effect (oral milrinone, intravenous dobutamine infusion), with the exception of levosimendan, when used in intermittent infusions in patients with advanced heart failure, which did not interfere with prognosis and avoided worsening quality of life and readmissions.
Omecamtiv mecarbil is an inotropic agent whose mechanism of action differs from the others, having no relation to increased calcium influx or increased sensitivity to calcium by myocardial fibers. The drug increases cardiac contractility by selectively interacting with cardiac myosin, increasing the number of molecules available to bind to actin and produce greater kinetic energy at the beginning of systole, without increasing calcium and/or oxygen consumption. Omecamtiv mecarbil binds to a site that stabilizes the molecule, promoting a greater number of actin-myosin interactions, increasing the amount of energy generated with each ventricular systole.
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