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(Circulation. 1997;95:1989-1991.)
© 1997 American Heart Association, Inc.

Articles

Through the Looking Glass

A Positive Inotropic Drug and Ischemic Preconditioning

Richard S. Vander Heide, MD, PhD; James D. Marsh, MD

the Program in Molecular and Cellular Cardiology, Departments of Pathology and Medicine, and Center for Molecular Medicine and Genetics, Harper Hospital and Wayne State University School of Medicine, Detroit, Mich.

Correspondence to James D. Marsh, MD, Wayne State University School of Medicine, 421 E Canfield Ave, Detroit, MI 48201. E-mail marsh@cardiology.harper.wayne.edu

Key Words: Editorials • infarction • inotropic agents • ischemia

	Introduction

 

`When I use a word,' Humpty Dumpty said in a rather scornful tone, `it means just what I choose it to mean—neither more nor less.'¹

—Lewis Carroll, Through the Looking Glass

But words may mean more or less than we suspect, and affixing a noun or adjective can constrain our thinking. That is a lesson that the Oxford mathematician and logician Charles Dodgson, otherwise known as Lewis Carroll, conveys in his satiric novel Through the Looking Glass, published 125 years ago. When we label a drug a "positive inotropic agent," does it make it so—neither more nor less? Apparently not. Escaping the constraints of a label, investigators have sought novel mechanisms of action of the drug vesnarinone, which has been under development as a positive inotropic agent for several years. There is no doubt that vesnarinone has positive inotropic effects, but in light of the creative thinking of Kitakaze and colleagues,² it appears that "vesnarinone" means more than that. Vesnarinone underwent extensive development and testing as a positive inotropic drug for use in congestive heart failure. The initial clinical studies using vesnarinone to treat heart failure demonstrated that in a dose of 60 mg/d, 6 months of therapy with vesnarinone resulted in a clear-cut decrease in morbidity and mortality and improved the quality of life for patients with congestive heart failure.³ However, higher doses of vesnarinone increased mortality, as well as inducing the troublesome side effect of neutropenia. Therefore, as a cardiotonic drug, vesnarinone has shown promise as an . . . [Full Text of this Article]