Hemodynamic effects of digoxin on congestive heart failure
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Digoxin effectively reduced heart rate and pulmonary capillary pressure in heart failure patients. While stroke volume increased, cardiac index did not consistently improve, suggesting a variable response to this heart failure treatment.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Congestive heart failure (CHF) presents challenges in hemodynamic management.
- Digoxin is a medication used to improve cardiac contractility.
Purpose of the Study:
- To evaluate the hemodynamic effects of a specific dose of digoxin (0.01 mg/kg) in patients with CHF.
- To assess digoxin's impact on left ventricular function and filling in different CHF etiologies.
Main Methods:
- Nineteen patients with reduced left ventricular ejection fraction (myocardial infarction, dilated cardiomyopathy) and 8 with impaired ventricular filling (mitral stenosis) received digoxin.
- Hemodynamic parameters including heart rate, pulmonary capillary pressure, stroke volume, blood pressure, and systemic vascular resistance were measured.
Main Results:
- Digoxin significantly decreased heart rate and pulmonary capillary pressure in both patient groups (p < 0.05).
- Stroke volume increased significantly in the mitral stenosis group (p < 0.05) but not significantly in the reduced ejection fraction group.
- No significant changes in blood pressure or systemic vascular resistance were observed.
Conclusions:
- Digoxin demonstrates a positive inotropic effect and reduces pulmonary capillary pressure in CHF patients.
- The increase in cardiac index following digoxin administration can be variable, indicating a nuanced response in CHF management.
Abstract:
To assess the hemodynamic effects of digoxin (0.01 mg/kg) on congestive heart failure, we evaluated 19 patients with decreased contraction force of left ventricle (old myocardial infarction n = 9, and dilated cardiomyopathy n = 10, group 1) and 8 patients with mechanical impaired left ventricular filing (mitral stenosis n = 8, group 2). In groups 1 and 2, heart rate and pulmonary capillary pressure significantly decreased (p less than 0.05). In group 1, stroke volume increased, but not significantly. In group 2, stroke volume increased significantly (p less than 0.05). There were no significant changes in blood pressure and systemic vascular resistance in either group. We divided group 1 into two groups (group 1A: cardiac index increased more than 15%, group 1B: cardiac index increased less than 15%). In group 1A, cardiac index and % fractional shortening before digoxin administration were lower than in group 1B (1.97 + 0.27 vs 2.80 + 0.481/min/m2, p less than 0.001, and 10.9 + 8.0 vs. 19.5 +11.9%, p less than 0.05, respectively). These data suggested that digoxin exerted a positive inotropic effect with decreased pulmonary capillary pressure but cardiac index did not always increase in congestive heart failure.