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[Digitalis therapy in chronic heart failure. Digitoxin in patients in sinus rhythm pretreated with diuretics]
H Sievert1, T Offermann, W D Bussmann
1Abteilung für Kardiologie, Universitätsklinikum Frankfurt/Main.
Insights
Digitoxin did not significantly improve symptoms or hemodynamics in patients with chronic heart failure already treated with diuretics. Further benefits from digitoxin were not observed in this study group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic heart failure (CHF) is a complex condition requiring multifaceted treatment.
- Diuretics are a cornerstone therapy for managing fluid overload in CHF patients.
- The role of cardiac glycosides like digitoxin in CHF requires ongoing investigation.
Purpose of the Study:
- To evaluate the additional effect of digitoxin on symptomatic and hemodynamic parameters in CHF patients already stabilized on diuretic therapy.
- To assess changes in cardiac volume, cardiac output, and other hemodynamic indices with digitoxin administration.
Main Methods:
- A study involving eight patients with chronic heart failure in sinus rhythm.
- Initial six-week treatment with individually adjusted diuretics (hydrochlorothiazide-triamterene and/or frusemide).
- Subsequent six-week administration of daily digitoxin (0.07-0.1 mg), with radiological cardiac volume, echocardiography, and invasive hemodynamic monitoring at rest and during exercise.
Main Results:
- Patients showed symptomatic improvement after diuretic treatment.
- Digitoxin administration resulted in a slight, non-significant increase in resting cardiac output (P < 0.1).
- Mean values for other hemodynamic parameters and cardiac volume remained unchanged.
Conclusions:
- Digitoxin did not provide significant additional clinical or hemodynamic benefits to patients with chronic heart failure in sinus rhythm who were already receiving optimal diuretic therapy.
- The findings suggest that digitoxin may not be a beneficial addition for improving outcomes in this specific patient population.
Abstract:
Eight patients in sinus rhythm with chronic heart failure were studied. After individually adjusted six-week treatment with diuretics (hydrochlorothiazide-triamtere and/or frusemide) all patients were clearly improved symptomatically. Subsequently they additionally received digitoxin for six weeks, 0.07-0.1 mg daily. Before and at the end of the digitoxin period cardiac volume was determined radiologically, echocardiography was performed and haemodynamic parameters determined at rest and on exercise via indwelling catheters. During digitoxin administration there was a slight increase in cardiac output from 4.63 +/- 0.82 to 5.05 +/- 0.98 l/min (P less than 0.1) at rest and from 7.22 +/- 1.94 to 7.79 +/- 2.59 l/min at rest. The mean values of all other haemodynamic parameters remained unchanged. These results suggest that in patients with chronic heart failure and sinus rhythm any clinical or haemodynamic improvement achieved will not be significantly bettered by digitoxin.