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Association Between Digoxin Use and Cardiac Function in Infants With Single-Ventricle Congenital Heart Disease During
Karan R Kumar1,2, Antonina Flair1, Elizabeth J Thompson1,2
1Duke Clinical Research Institute, Durham, NC.
Insights
Digoxin use in infants with single-ventricle congenital heart disease may help maintain cardiac function during the interstage period. Further trials are needed to confirm its safety and effectiveness in this population.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Physiology
Background:
- Infants with single-ventricle (SV) congenital heart disease (CHD) often experience a decline in cardiac function between surgical palliation stages.
- The interstage period is critical for managing these complex cardiac conditions.
Purpose of the Study:
- To investigate the association between digoxin use and echocardiographic indices of cardiac function in infants with SV CHD during the interstage period.
- To determine if digoxin influences cardiac performance in this vulnerable patient group.
Main Methods:
- Retrospective cohort study involving 373 infants across 15 North American hospitals.
- Analysis compared cardiac function (end-systolic volume, ejection fraction, etc.) in infants discharged with or without digoxin after stage 1 palliation.
Main Results:
- 140 (37.5%) infants received digoxin during the interstage period.
- Digoxin use was associated with a smaller increase in end-systolic volume and a smaller decrease in ejection fraction and fractional area change.
- These findings suggest digoxin may mitigate the decline in cardiac function.
Conclusions:
- Digoxin may offer partial protection against the expected decrease in cardiac function during the interstage period in SV CHD infants.
- Prospective clinical trials are necessary to confirm the pharmacokinetics, safety, and efficacy of digoxin in this setting.
Objectives:
To examine the association between digoxin use and cardiac function assessed by echocardiographic indices in infants with single-ventricle (SV) congenital heart disease (CHD) during the interstage period.
Design:
Retrospective cohort study.
Setting:
Fifteen North American hospitals.
Patients:
Infants discharged home following stage 1 palliation (S1P) and prior to stage 2 palliation (S2P). Infants with no post-S1P and pre-S2P echocardiograms were excluded.
Interventions:
None.
Measurements And Main Results:
Of 373 eligible infants who met inclusion criteria, 140 (37.5%) were discharged home on digoxin. In multivariable linear and logistic regressions, we found that compared with infants discharged home without digoxin, those discharged with digoxin had a smaller increase in end-systolic volume (β = -8.17 [95% CI, -15.59 to -0.74]; p = 0.03) and area (β = -1.27 [-2.45 to -0.09]; p = 0.04), as well as a smaller decrease in ejection fraction (β = 3.38 [0.47-6.29]; p = 0.02) and fractional area change (β = 2.27 [0.14-4.41]; p = 0.04) during the interstage period.
Conclusions:
Digoxin may partially mitigate the expected decrease in cardiac function during the interstage period through its positive inotropic effects. Prospective clinical trials are needed to establish the pharmacokinetics, safety, and efficacy of digoxin use in SV CHD.
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