The Effects of the Cardiac Glycosides Upon the Dynamics of the Circulation in Congestive Heart Failure. I. Ouabain 12

Bloomfield, Richard A.; Rapoport, Bernard; Milnor, J. P.; Long, Walter K.; Mebane, J. Gilmer; Ellis, Laurence B.; Lavin, M. Rita

doi:10.1172/jci102004

Cited by 91 publications

(21 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2 Composite recording of transmitral (A) and transpulmonary (B) venous flows in a 60-year-old male patient with idiopathic dilated cardioniyopathy and a lesser degree of left ventricular systolic dysFunction (EF 35%). Transmitral flow was characterized by an inverted E/A ratio; a normal biphasic pulmonary venous flow was detected.…”

Section: Present Studymentioning

confidence: 99%

Effects of intravenous digoxin on pulmonary venous and transmitral flows in patients with chronic heart failure of different degrees

Giunta

Maione

Arnese

et al. 1995

Clinical Cardiology

View full text Add to dashboard Cite

Summary: Acute effects of digoxin on diastole were evaluated noninvasively by combining data simultaneously obtained by Doppler echocardiograms (echo-Doppler) of transmitral and pulmonnry venous flow curves in 38 patients with dilated and Failing heai-ls, who had been stable for at least 7 days before the study. According to the resting ejection fraction (EF), patients were subdivided into Group 1 (EF < 30%: n = 20, iiiean BF values 33 ? 8%) and Group 2 (EF 2 30%': n = 18, mean EF values 40 ? 3% ). Significant differences were observed at rest between the two goups in both transmitral (shorter deceleration time and isovoluniic relaxation time and increased peak E and E/A ratio in Group 1 vs. Group 2 ) and transpdmonary ( reduced systolic forward component and systolic fraction ofthe flow curves in Group I compared with Gro~ip 2 and control subjects) paranieters. Digoxin ( 1 mg subdivided into two doses, each infused over a IS-min period with 2 h between the doses) significantly modified the diastolic prolile in Group 1 patients in the absence of statistically relevant changes in EF: a significant decrease of transniitnd peak E (from 76 f 17 to 60 k I5 cmds, p < 0.05) and E/A ratio (from 2.5 k 1 to 1.6 k 0.6; p < 0.05) and a significant lengthening ofdeceleratioii time (from I I5 k 20 to I60 k 18 ms; p < 0.05) were detected. A simultaneous consistent decrease of the diastolic foiwxd velocity (from 5 1 k 14 to 40 k 13 cm/s, p < 0.05) and an increase of the percent systolic fraction (from 3 1 k 5% to 41 +-8%; p < 0.05) of the pulmonary venous flow curves, compared with the control state (p < 0.05), were also observed. N o difference was detected in any ofthe echo-Doppler transmitral and transpulmonary vein flow parameters after digoxin in Group 2 of patients. Among patients with dilated and failing hearts, those with more advanced left ventricular systolic dysfunction (EF < 30%) exhibited a diastolic profile characterized by a restrictive transmitral filling pattern combined with a clear reduction of systolic fraction and with an increase in the diastolic forward component of the pulmonary venous flow curves. These patients show significant changes in diastolic parameters after digoxin injection, expressed by a trend toward a nornialized transmitral filling flow pattern (significant decrease of peak E, EJA ratio, and significant lengthening of deceleration time) and toward a restoration ofthe amount of systolic left atrial filling at the pulmonary venous flow curves (significant increase in systolic fraction and significant decrease in the diastolic forward component). These changes are consistent with a reduction of left ventricular driving pressures. Conversely, pdtients with a lesser degree of systolic dysfunction exhibited a normal pulmonary venous tlow profile together with a transmitral filling pattern of abnormal relaxation type: in these patients no changes were observed in any of the echo-Doppler transmitral and transpulmonary vein flow parameters after acutely injected digoxin.

show abstract

Section: Present Studymentioning

confidence: 99%

Effects of intravenous digoxin on pulmonary venous and transmitral flows in patients with chronic heart failure of different degrees

Giunta

Maione

Arnese

et al. 1995

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…The digitalis glycoside produced no, or minimal, hemodynamic effects in the 3 types of noncardiac circulatory congestion, in contrast to prompt and decided improvement in hemodynamic functions in congestive heart failure (figs. 6-9).1 2,4,40,41 The cardiac output in congestive heart failure (CHE) increased from typically low values to normal levels within 1 to 2 hours after the intravenous administration of digoxin ( fig. 6).…”

Section: Circulatory Congestion As An Index Ofmentioning

confidence: 99%

“…Three prinicipal areas will be considered: (1) the nature of circulatory congestion and its significance as an index of heart failure, (2) the effect of the circulatory congestion itself on the function of the heart and on the function of one peripheral organ, the kidney, and (3) the relation of lowered cardiac output to circulatory congestion anid to activity and survival. Supported by grants-in-aid froni the New York Heart Association, Inc., the Life Insurance Medical Research Fund, and the National Heart Institute, U. S. Public Health Service.…”

mentioning

confidence: 99%

The George E. Brown Memorial Lecture

Eichna

1960

Circulation

View full text Add to dashboard Cite

“…The successful use of digitalis glycosides in the treatment of low output cardiac failure is mainly attributed to the positive inotropic effect of digitalis glycosides and the accompanying increase in cardiac output and reduction of elevated ventricular diastolic pressure (1,2). Under some circumstances, however, the glycosides do not exert an obviously beneficial effect on the circulation, e.g., acetylstrophanthidin in experimental myocardial infarction (3).…”

Section: Introductionmentioning

confidence: 99%

Digitalis-Induced Increase in Aortic Regurgitation and the Contrasting Effects of Glucagon in the Sedated Dog

Hopkins¹,

Taylor²

1974

J. Clin. Invest.

View full text Add to dashboard Cite

A B S T R A C T The hemodynamic and phasic ascending aortic flow changes induced by acetylstrophanthidin and glucagon were studied in closed-chest sedated dogs with aortic regurgitation. While the positive inotropic effect of both agents was reflected in an increase in peak rate of rise of left ventricular pressure, acetylstrophanthidin increased aortic regurgitation, while glucagon decreased it. With the former, left ventricular end-diastolic pressure rose from 20±6 to 27+6 mm Hg (P < 0.005), but fell from 18+4 to 11±3 mm Hg (P < 0.001) with glucagon. Acetylstrophanthidin increased systemic vascular resistance, aortic diastolic pressure, and diastolic regurgitant flow rate, and, heart rate and the duration of regurgitation per beat and per minute being unchanged, regurgitant flow per beat increased 32±15% (P <0.001). Glucagon decreased regurgitant flow per beat 27±14% (P < 0.001) because of abbreviation of diastole associated with tachycardia, and because of reduction in regurgitant flow rate. Despite tachycardia, the duration of regurgitation per minute was unchanged, and the small fall in regurgitant blood flow per minute was not significant, but this pertained in the face of 47% increase in effective cardiac output (P < 0.001). In contrast, acetylstrophanthidin increased regurgitant flow per minute 28±14% (P < 0.001) without change in effective cardiac output. The increase in cardiac contractility, tachycardia, and systemic vasodilatation induced by glucagon preferentially enhanced forward blood flow, which led to reduction in left ventricular volume overload, while it increased cardiac output. Contrarily, acetylstrophanthidin increased aortic regurgitation and, despite its inotropic effect, increased left ventricular volume overload without an increase in cardiac output.

show abstract

The Effects of the Cardiac Glycosides Upon the Dynamics of the Circulation in Congestive Heart Failure. I. Ouabain 12

Cited by 91 publications

References 4 publications

Effects of intravenous digoxin on pulmonary venous and transmitral flows in patients with chronic heart failure of different degrees

Effects of intravenous digoxin on pulmonary venous and transmitral flows in patients with chronic heart failure of different degrees

The George E. Brown Memorial Lecture

Digitalis-Induced Increase in Aortic Regurgitation and the Contrasting Effects of Glucagon in the Sedated Dog

Contact Info

Product

Resources

About