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Long-term digitalis therapy improves left ventricular function in heart failure
Insights
Long-term oral digoxin therapy improves hemodynamics in patients with symptomatic heart failure. Stopping digoxin worsened heart function, while readministration restored benefits, confirming its value.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Digoxin is a common treatment for heart failure.
- The benefits of long-term oral digoxin therapy remain debated.
Purpose of the Study:
- To evaluate the hemodynamic effects of long-term oral digoxin in patients with symptomatic heart failure.
Main Methods:
- Nine patients in sinus rhythm with heart failure were studied.
- Hemodynamics were assessed at rest and during exercise during long-term digoxin therapy, after drug withdrawal, and after readministration.
Main Results:
- Digoxin withdrawal led to increased pulmonary capillary-wedge pressure and decreased cardiac index, indicating worsened left ventricular function.
- Stroke-work index, stroke-volume index, and ejection fraction also decreased upon digoxin withdrawal.
- Acute readministration of digoxin restored hemodynamic values, with similar improvements observed during exercise.
Conclusions:
- Long-term oral digoxin therapy provides significant hemodynamic benefits in patients with symptomatic heart failure.
- Withdrawal of digoxin results in deterioration of cardiac function.
- Digoxin therapy is valuable for managing congestive heart failure.
Abstract:
To clarify the controversy regarding the benefits of long-term oral digoxin in the treatment of heart failure, we evaluated hemodynamics at rest and during exercise in nine patients in sinus rhythm with symptomatic heart failure. Patients were studied during long-term digoxin therapy, after withdrawal of the drug, and six hours after readministration. Upon withdrawal of digoxin, pulmonary capillary-wedge pressure increased from 21 +/- 8 to 29 +/- 10 mm Hg, and cardiac index decreased from 2.4 +/- 0.7 to 2.1 +/- 0.6 liters per minute per square meter of body-surface area, suggesting a deterioration in left ventricular function. In addition, heart rate tended to increase and stroke-work index, stroke-volume index, and radioangiographic ejection fraction decreased. Acute readministration restored the hemodynamic values to those observed during long-term digoxin therapy. The improvement in hemodynamics during long-term digoxin administration was also observed during exercise. This improvement demonstrated the value of long-term oral digoxin therapy in congestive heart failure.