Hemodynamic effects of intravenous digoxin in patients with severe heart failure initially treated with diuretics and vasodilators

Abstract

The purpose of this study was to assess the hemodynamic effects of intravenous digoxin in patients with New York Heart Association class IV heart failure, who had never previously been treated with digitalis drugs, and who were initially treated only with diuretics and systemic vasodilators to clinical end points of compensation. Eleven male patients, 5 with idiopathic and 6 with ischemic cardiomyopathy, had sinus rhythm and were hospitalized with congestive heart failure not precipitated by an acute ischemic event. All 11 patients were treated with intravenous furosemide and various vasodilators without invasive hemodynamic monitoring for a mean period of 4.3 +/- 2.1 days. This therapy resulted in subjective and objective improvement in all patients as reflected by a significant decrease in heart failure score from 9.5 +/- 2.2 to 2.7 +/- 2.3 (p less than 0.001). When compensation was achieved by clinical criteria, the patients were instrumented and hemodynamics obtained before and serially thereafter for 6 hours after the intravenous administration of digoxin given in two 0.5 mg doses 2 hours apart. In response to digoxin, cardiac index increased from 2.6 +/- 0.7 liters/min per m2 to a peak of 3.3 +/- 0.6 liters/min per m2 (p less than 0.005); left ventricular stroke work index (g X m/m2) increased from 27 +/- 16 to 43 +/- 23 (p less than 0.005) and the ejection fraction (eight patients) increased from 21 +/- 13% to 29 +/- 11% (p less than 0.04). Mean pulmonary capillary wedge pressure decreased from 24 +/- 7 to a minimum of 17 +/- 4 mm Hg (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Digitalis: new actions for an old drug

“…86 for review). Clinically, it is important to note that the hemodynamic benefits of glycosides have been reported to be directly related to the severity of CHF (42), underscoring the importance of altered NKA expression, pump reserve, and the sensitivity to glycoside effects in CHF.…”

Comparative Hemodynamic Effects of Intravenous Digoxin and Enoximone in Severe Chronic Heart Failure

“…Ribner et al [ 17] showed no change in systemic vascular resistance and only a modest reduc tion of pulmonary wedge pressure in re sponse to intravenous digoxin. Gheorghiade et al [18] showed no change in systemic vas cular resistance in patients with clinically compensated failure. On the other hand, in patients with severe heart failure and high wedge pressure (35 ± 8 mm Hg), Gheorgh iade et al [19] showed a significant reduction of pulmonary wedge pressure and systemic vascular resistance in response to intrave nous digoxin.…”

“…Digitalis glycosides improve myocardial contraction [8]; however, the increase in ino tropic state does not always translate into improved cardiac performance as expressed by cardiac output and left-ventricular filling pressure [2], In patients with congestive heart failure, intravenous digoxin produces a mod est decline in heart rate, a variable increase of mean arterial blood pressure, a modest increase of cardiac output, and an increase of left-ventricular ejection fraction [17,18]. The changes of pulmonary wedge pressure and systemic vascular resistance in response to intravenous digoxin vary considerably.…”

Digoxin in the Management of Cardiovascular Disorders

“…In HF, however, when hemodynamics are normalized first with diuretics and vasodilators, no further improvement in pulmonary capillary wedge pressure or cardiac output is achieved after the acute administration of digoxin. 6,7 The improvement in hemodynamics is sustained during chronic therapy. 8 …”