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Heart failure in patients with preserved left ventricular systolic function: do digitalis glycosides have a role?
1Department of Medicine, University of California, San Francisco, USA.
Insights
Digoxin therapy may be beneficial for patients with congestive heart failure (CHF) and preserved systolic function, challenging previous assumptions. This finding offers new treatment possibilities for a significant patient group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- A substantial number of congestive heart failure (CHF) patients exhibit preserved systolic function.
- These patients experience significant symptoms and hospitalizations, often attributed to diastolic dysfunction.
- Treatment strategies for CHF with preserved systolic function are not well-established.
Purpose of the Study:
- To review the causes of CHF with preserved systolic function.
- To examine the potential mechanisms of digoxin's efficacy in this patient group.
Main Methods:
- Review of existing literature on CHF with preserved systolic function.
- Analysis of data from the Digitalis Investigators Group trial, focusing on a subgroup with ejection fractions >= 45%.
Main Results:
- The Digitalis Investigators Group trial unexpectedly showed similar reductions in heart failure endpoints with digoxin in patients with preserved systolic function (ejection fraction >= 45%) compared to those with lower ejection fractions.
- This challenges the long-held belief that digoxin is inappropriate for this patient population.
Conclusions:
- Digoxin may offer a beneficial effect in patients with congestive heart failure and preserved systolic function.
- Further investigation into the mechanisms of digoxin's action in this context is warranted.
Abstract:
It is being increasingly appreciated that a substantial number of patients with congestive heart failure (CHF) have relatively preserved systolic function. Although these individuals appear to have a somewhat better prognosis than those with low ejection fractions, they experience significant symptoms and frequently require hospitalization. In these patients, CHF is often attributed to left ventricular diastolic dysfunction, but this represents a potentially misleading over-simplification. In contrast to CHF associated with left ventricular systolic dysfunction, little is known about how to treat patients with preserved systolic function. Perhaps the major point of consensus has been that the use of digitalis glycosides is inappropriate in this group. Unexpectedly, however, in the recently completed Digitalis Investigators Group trial, a subgroup of nearly 1,000 patients with radionuclide ejection fractions > or = 45% experienced a similar reduction in heart failure endpoints with digoxin therapy as patients with 25% to 44% ejection fractions. The purpose of this article is to review the diverse causes of CHF with preserved systolic function and to examine the potential mechanisms by which digoxin may be producing beneficial effect in this setting.