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Widely differing plasma digoxin values in patients with congestive heart failure and severe liver dysfunction. A

A A Nanji, D C Greenway

    Archives of Pathology & Laboratory Medicine
    |January 1, 1986
    PubMed
    Summary

    Plasma digoxin levels vary significantly in severe heart failure patients with liver dysfunction. Different measurement methods reveal discrepancies, likely due to a digoxin-like substance.

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    Area of Science:

    • Pharmacology
    • Clinical Chemistry
    • Cardiology

    Background:

    • Congestive heart failure (CHF) can lead to secondary liver dysfunction.
    • Accurate monitoring of cardiac glycosides like digoxin is crucial in CHF management.
    • Existing methods for measuring plasma digoxin may be affected by altered physiological states.

    Purpose of the Study:

    • To investigate the impact of liver dysfunction secondary to CHF on plasma digoxin levels.
    • To compare the performance of three different analytical methods for digoxin measurement in patients with varying degrees of liver dysfunction.
    • To identify potential causes for discrepancies in digoxin measurements.

    Main Methods:

    • Plasma samples were collected from patients with congestive heart failure and no, mild to moderate, or severe liver dysfunction.

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  • Digoxin levels were determined using three distinct assay methodologies.
  • Statistical analysis was performed to compare results across different patient groups and methods.

    • Main Results:

    • Significant discrepancies in plasma digoxin measurements were observed in patients with severe liver dysfunction.
    • The degree of discrepancy varied depending on the specific assay method used.
    • A digoxin-like immunoreactive substance was implicated as a potential cause for these observed differences.

    Conclusions:

    • Liver dysfunction secondary to congestive heart failure can profoundly affect plasma digoxin measurements.
    • Assay methodology is a critical factor influencing digoxin level accuracy in patients with severe hepatic impairment.
    • The presence of interfering substances necessitates careful consideration of analytical methods in this patient population.