Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Adenosine 5'-triphosphate disodium (ATP) has been explored as a supportive therapy in congestive heart failure (CHF), primarily due to its fundamental role as the primary energy carrier in cellular metabolism. The rationale is that ATP supplementation might help improve myocardial energy metabolism, contractility, and overall cardiac function in patients with heart failure, who often exhibit impaired myocardial energy status.

Scientific investigations into intravenous ATP administration for CHF date back to the 1980s and 1990s. Early clinical studies, such as those by Belardinelli et al. (1991), demonstrated that intravenous ATP could produce beneficial hemodynamic effects, such as reduced systemic vascular resistance and increased cardiac output, likely via vasodilation and improved myocardial efficiency. However, these effects were generally transient and required continuous infusion.

Despite these promising findings, subsequent larger-scale and long-term studies have been limited. The use of ATP is not incorporated into clinical guidelines for CHF management by major cardiology societies. The evidence base is limited to small trials and short-term physiological studies, with a lack of robust data demonstrating long-term clinical benefit, improved survival, or symptom reduction. Moreover, oral ATP is rapidly metabolized in the gut, making intravenous administration necessary for any pharmacologic effect, which limits its practicality and widespread use.

In summary, there is some scientific rationale and limited clinical evidence supporting ATP use in CHF, but the quality and quantity of evidence is low, and it is not a standard or widely endorsed therapy.

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