Restoring Cardiac Contractility

Reversible Causes of Reduced Contractility

The American College of Radiology suggests that dysfunctional but viable myocardium demonstrates "contractile reserve" - the ability to increase contractility during inotropic stimulation, indicating potential for recovery 1
Revascularization in patients with viable myocardium can lead to recovery of myocardial function and clinical improvement, as recommended by the American College of Radiology 1
The European Heart Journal notes that control of persistently elevated ventricular rate can lead to reversal of the myopathic process in tachycardia-induced cardiomyopathy 2
Cardiac resynchronization therapy (CRT) can enhance ventricular contraction by electrically synchronizing right and left ventricular activation, according to Circulation 3, 4, 5
CRT significantly improves ejection fraction in addition to quality of life and functional capacity, as reported in Circulation 3, 4
Mortality reduction of 25-36% has been demonstrated with CRT, with effects becoming apparent after approximately 3 months, as noted in Circulation 3, 4, 5

Relief of aortic stenosis significantly increases blood pressure and forward stroke volume after transcatheter aortic valve replacement (TAVR), as reported in the European Journal of Heart Failure 6
Transcatheter edge-to-edge repair (TEER) can enhance forward cardiac flow by reducing regurgitant backflow, according to the European Journal of Heart Failure 6

If regional dysfunction is predominantly due to prior infarction, revascularization confers no benefit, as noted in the Journal of the American College of Radiology 1
The American College of Cardiology recommends that intermittent infusions of positive inotropic agents should not be used in long-term treatment of heart failure, even in advanced stages 7
Drug therapies aimed at increasing contractility have been associated with increased risk of death in some trials, as reported in the Journal of the American College of Cardiology 7

The American College of Radiology suggests assessing for hibernating myocardium using viability imaging (PET, SPECT, or CMR with late gadolinium enhancement) to identify reversible causes of reduced contractility 1
The European Heart Journal recommends evaluating for tachycardia-induced cardiomyopathy by assessing ventricular rate control 2
Circulation notes that checking QRS duration >120 ms and NYHA class III-IV symptoms is essential for CRT candidacy 3, 4