Calcitropes, Myotropes and Mitotropes: The Role of Novel Agents to Improve Systolic Function in HFrEF

0.50 CME
$0 FEE
Calcitropes, Myotropes and Mitotropes: The Role of Novel Agents to Improve Systolic Function in HFrEF


Provider Statement

This continuing medical education activity is provided by Vindico Medical Education

Support Statement

This activity is supported by an educational grant from Cytokinetics, Inc.

Activity Description

Reductions in myocardial contractile function and increases in cardiac wall stress can trigger multiple interrelated compensatory mechanisms, including neurohormonal activation and ventricular remodeling. These result in increased myocardial oxygen demand and reduced contractile efficiency, promoting additional myocardial injury and cardiomyocyte death. These effects perpetuate a negative feedback cycle that results in symptomatic heart failure with a reduced ejection fraction (HFrEF) and, eventually, death.

Multiple lifesaving therapies, including angiotensin converting enzyme inhibitors; angiotensin receptor blockers; mineralocorticoid antagonists; beta blockers; and, most recently, dual-acting angiotensin receptor-neprilysin inhibitors, have been developed to address the neurohormonal activation in HFrEF. However, these therapies do not directly address the central driver in the pathogenesis of HFrEF—decreased myocardial contractility, resulting in decrease systolic function. The use of conventional inotropic agents may increase morbidity as well as mortality and are associated with a higher risk of ventricular arrhythmia, atrial fibrillation, hypotension, induced myocardial ischemia, increased myocardial oxygen consumption, and direct myocyte toxicity due to an intracellular calcium overload.

Pharmacologic agents that improve myocardial performance can be classified as calcitropes that alter intracellular calcium concentrations, myotropes that affect the molecular motor and scaffolding, and mitotropes that influence the myocardial energetics. In this educational activity, faculty will discuss the latest data regarding newer agents in development that can directly enhance myocardial contractility, without increasing cardiac workload or oxygen consumption. 

Target Audience

The intended audience for this activity is cardiologists and other health care professionals involved in the management of patients with heart failure with reduced ejection fraction.

Learning Objective

Upon successful completion of this educational activity, participants should be better able to:

  • Describe the benefits and pitfalls of traditional inotropic agents and their impact on long-term outcomes in the treatment of HFrEF.
  • Evaluate new terminology with mechanistic nomenclature to foster effective communication and highlight novel therapeutic agents to improve myocardial contractility and function.
  • Assess the unique mechanisms of action of cardiac myotropes and clinical evidence regarding their safety and efficacy in the treatment of HFrEF.

Actvity Chair

Professor of Medicine, University of California, San Francisco
Director, Heart Failure Program
Director, Echocardiography
San Francisco VA Medical Center
Professor of Medicine, University of California San Francisco
San Francisco, CA


Mitchell A. Psotka, MD, PhD, FACC, FHFSA
Director, Infiltrative Cardiomyopathy Center
Associate Director, Heart Failure Research
Inova Heart and Vascular Institute
Falls Church, VA


Ronald A. Codario, MD, EMBA, FACP, FNLA, RPVI, CHCP


Vindico Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

Vindico Medical Education designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This enduring material is approved for 1 year from the date of original release, December 28, 2020, to December 27, 2021.

How to Participate in This Activity and Obtain CME Credit

To participate in this CME activity, you must read the objectives, answer the polling and pretest questions, view the activity, and complete the CME posttest and evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 2 out of 3 of the posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, Vindico Medical Education will issue an AMA PRA Category 1 Credit(s)™ Certificate.


In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all accredited providers are required to mitigate and disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of accredited content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the past 12 months with a commercial interest whose products or services are discussed in the accredited activity content over which the individual has control. Relationship information appears below. 

Activity Chair and Faculty report the following relationship(s)

Consulting Fee: Abbott Medical Optics, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cytokinetics, Medtronic, Merck, Novartis
Contracted Research: Abbott Medical Optics, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cytokinetics, Medtronic, Novartis

Mitchell A. Psotka, MD, PhD, FACC, FHFSA
Consulting Fee: Amgen, Cytokinetics, Windtree

Reviewer reports the following relationship(s)

Ronald A. Codario, MD, EMBA, FACP, FNLA, RPVI, CHCP
No relevant financial relationships to disclose. 

Vindico Medical Education staff report the following relationship(s)

No relevant financial relationships to disclose.

Signed disclosures are on file at Vindico Medical Education, Office of Medical Affairs and Compliance.

Unlabeled and Investigational Usage

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of US Food and Drug Administration (FDA)-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non—FDA-approved or investigational use of products/devices.

Copyright Statement

Created and published by Vindico Medical Education, 6900 Grove Road, Building 100, Thorofare, NJ 08086-9447. Telephone: 856-994-9400; Fax: 856-384-6680. Printed in the USA. Copyright © 2020 Vindico Medical Education. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. The material presented at or in any of Vindico Medical Education continuing medical education activities does not necessarily reflect the views and opinions of Vindico Medical Education. Neither Vindico Medical Education nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the US Food and Drug Administration. All readers and continuing education participants should verify all information before treating patients or utilizing any product.

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