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Hemodynamic effects of digoxin in acute myocardial infarction in man: a randomized controlled trial
Insights
Digoxin improved cardiac function in acute myocardial infarction patients with reduced left ventricular stroke work index and normal pulmonary capillary wedge pressure. This study stratified patients into four hemodynamic subsets to evaluate digoxin
Area of Science:
- Cardiology
- Pharmacology
- Critical Care Medicine
Background:
- The hemodynamic effects of digoxin in acute myocardial infarction (AMI) are influenced by the patient's baseline cardiocirculatory state.
- Previous research suggests a variable response to digoxin based on hemodynamic parameters.
Purpose of the Study:
- To evaluate the effects of digoxin in patients with AMI, stratified into four distinct hemodynamic subsets.
- To determine if digoxin administration improves hemodynamic parameters in specific patient populations with AMI.
Main Methods:
- Forty patients with AMI were categorized into four hemodynamic subsets based on mean pulmonary capillary wedge pressure (PCWP) and left ventricular stroke work index (LVSWI).
- Patients were randomly assigned to receive either intravenous digoxin (0.50 mg) or a placebo.
- Hemodynamic parameters, including cardiac index (CI), were measured at 30, 60, and 90 minutes post-infusion.
Main Results:
- Digoxin showed no significant effect in patients with normal PCWP and normal LVSWI (subset 1) or elevated PCWP and normal LVSWI (subset 2).
- A significant increase in cardiac index (CI) was observed in patients with reduced LVSWI and normal PCWP (subset 3) after digoxin administration.
- Hemodynamic data remained stable in the control group across all subsets.
Conclusions:
- Digoxin demonstrates a specific beneficial effect on cardiac output in a subset of AMI patients characterized by reduced left ventricular contractility (low LVSWI) and preserved filling pressures (normal PCWP).
- The findings highlight the importance of hemodynamic profiling in guiding digoxin therapy for AMI patients.
- Further research may explore optimal dosing and long-term outcomes in this specific patient subset.
Abstract:
Hemodynamic effects of digoxin in acute myocardial infarction (AMI) have been acknowledged to depend on the basal cardiocirculatory state. In the present study, the effects of digoxin in patients with AMI were evaluated in four hemodynamic subsets, based on the relationship between mean pulmonary capillary wedge pressure (PCWP, in mm Hg) and left ventricular stroke work index (LVSWI, in g-m/m2): subset 1: normal (less than or equal to 15 mm Hg) PCWP and normal (greater than or equal to 35 g-m/m2) LVSWI; subset 2: elevated (greater than 15 mm Hg) PCWP and normal LVSWI; subset 3: reduced (less than 35 g-m/m2) LVSWI and normal PCWP; and subset 4: elevated PCWP and LVSWI moderately reduced to a range between 16 and 34 g-m/m2. Forty patients were admitted to the study and were randomly assigned to one of two groups in each subset: control group (19 patients) and treated group (21 patients). Five patients were randomized into each of the subsets 2, 3, and 4 in both the control and treated groups, while in subset 1 there were four control and six digoxin-treated patients. Control patients were administered a placebo saline solution and digoxin-treated patients received 0.50 mg of the drug intravenously in 20 minutes. The effects of the placebo and of the drug were evaluated at 30, 60, and 90 minutes from the end of the infusion. Hemodynamic data did not vary in the control group, and digoxin did not exert any relevant effect in subsets 1 and 2. After drug infusion, cardiac index (Cl, in L/min/m2) significantly increased in subset 3 patients.(ABSTRACT TRUNCATED AT 250 WORDS)