Long-Term Digitalis Therapy Improves Left Ventricular Function in 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.

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults

“…370 The principal adverse reactions occur primarily when digoxin is administered in large doses, but large doses may not be needed to produce clinical benefits. [371][372][373] The major side effects include cardiac arrhythmias (e.g., ectopic and re-entrant cardiac rhythms and heart block), gastrointestinal symptoms (e.g., anorexia, nausea, and vomiting), and neurological complaints (e.g., visual disturbances, disorientation, and confusion). Overt digitalis toxicity is commonly associated with serum digoxin levels greater than 2 ng per mL.…”

The role of digitalis in the future.

“…Direct measurement of contractility and haemodynamics strongly supports the view that the positive inotropic effect of digoxin is maintained on chronic treatment both in papillary muscles isolated from cats (Williams & Potter 1975) and in man (Arnold et al, 1980;Lee et al, 1982). Murray et al (1982) demonstrated no effect of digoxin in patients at rest but an increased cardiac index and reduced left ventricular pressure on exercise after 6 weeks' treatment.…”

Is there a role for positive inotropic agents in congestive heart failure: Focus on mortality

“…Digoxin produces immediate and sustained increases in cardiac output and left ventricularejection fraction and decreases cardiac filling pressures in patients with CHF.". 23 Withdrawal of digoxin therapy from patients with CHF leads to symptomatic and functional deterioration. ", ?…”