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Is digoxin really important in treatment of compensated heart failure? A placebo-controlled crossover study in
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Digoxin therapy showed minimal impact on cardiac function in compensated heart failure patients. Long-term use did not significantly improve clinical outcomes or exercise capacity.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) management often involves cardiac glycosides.
- The role of digoxin in compensated CHF with normal sinus rhythm requires further clarification.
Purpose of the Study:
- To evaluate the efficacy of digoxin in patients with chronic, compensated congestive heart failure and normal sinus rhythm.
Main Methods:
- A double-blind, placebo-controlled crossover study was conducted.
- 30 outpatients received digoxin and placebo, with monitoring of serum digoxin levels, clinical status, and cardiac function indexes.
- Echocardiography and exercise capacity tests were utilized.
Main Results:
- No clinical deterioration was observed during placebo administration.
- Digoxin withdrawal led to minor, statistically significant changes in left ventricular dimensions and fiber shortening velocity.
- Maximal exercise capacity remained unchanged, and no clinical exacerbations occurred during long-term follow-up.
Conclusions:
- Long-term digoxin therapy demonstrates a minor effect on cardiac performance in ambulatory patients with compensated CHF.
- This effect appears to lack significant clinical importance for this patient population.
Abstract:
To assess the efficacy of digitalis in patients with chronic clinically compensated congestive heart failure and normal sinus rhythm, we performed a double-blind crossover study with digoxin and placebo in 30 consecutive outpatients fulfilling these criteria; serum digoxin levels, clinical symptoms and signs, and objective indexes of cardiac function were monitored. No patient's clinical condition deteriorated during three months of placebo administration. Discontinuation of digoxin resulted in a small increase in echocardiographically determined resting left ventricular end-diastolic dimension (1.8 +/- 0.6 mm, p less than 0.001) and a similar decrease in velocity of circumferential fiber shortening (-0.08 +/- 0.04 circ/sec, p less than 0.05) from the corresponding values of 55.8 +/- 2.3 mm and 0.90 +/- 0.08 circ/sec during digitalis therapy. Resting left ventricular ejection time and pre-ejection period were prolonged by digoxin withdrawal. Maximal exercise capacity was unchanged. No clinical exacerbation of heart failure attributable to digitalis withdrawal occurred over a follow-up period averaging 19 months. The results indicate that long-term digoxin therapy has only a minor effect on cardiac performance that is without apparent clinical importance in a representative population of ambulatory patients treated with cardiac glycosides.