title: Effect of digoxin on contractility and symptoms in infants with a large ventricular septal defect.
abstract: The effect of digoxin on contractility and symptoms in infants with a large ventricular septal defect (VSD) is controversial. Nineteen infants with symptoms of congestive heart failure due to a VSD were studied with load-independent indexes during 4 study periods: (1) before any medication; (2) while on chronic diuretics; (3) while on both diuretics and digoxin; and (4) while on diuretics alone, to determine if digoxin: (a) increases "contractility" when added to diuretic therapy; and (b) improves symptoms. Symptoms, signs (heart and respiratory rates, and weight gain), shortening fraction, preload (left ventricular end-diastolic dimension), afterload (left ventricular end-systolic wall stress) and contractility were measured at each period. The difference between the measured and predicted velocities of circumferential fiber shortening for the measured left ventricular end-systolic wall stress served as an index of contractility. Eighteen infants also underwent catheterization. Mean pulmonary-to-systemic blood flow ratio was 3:1. When digoxin was added to diuretics, contractility index was significantly greater than in control subjects (0.13 +/- 0.15 vs 0.0 +/- 0.12 circ/s, p = 0.04). When patients were again on diuretics alone (after discontinuation of digoxin), contractility index was no longer different. Symptoms and signs were not significantly improved by either diuretics or digoxin. It is concluded that in infants with a large left-to-right VSD shunt and receiving digoxin and diuretics, contractility index was significantly greater than in control subjects. However, neither diuretics alone nor in combination with digoxin improved symptoms significantly.
authors.affiliation: Division of Cardiology, Children's Hospital Medical Center, Cincinnati, Ohio 45229.
authors.forename: T R
authors.initials: TR
authors.lastname: Kimball
authors.forename: S R
authors.initials: SR
authors.lastname: Daniels
authors.forename: R A
authors.initials: RA
authors.lastname: Meyer
authors.forename: D W
authors.initials: DW
authors.lastname: Hannon
authors.forename: J
authors.initials: J
authors.lastname: Tian
authors.forename: R
authors.initials: R
authors.lastname: Shukla
authors.forename: D C
authors.initials: DC
authors.lastname: Schwartz
mesh_terms: D004077:Digoxin / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004452:Echocardiography; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D009200:Myocardial Contraction / Q000187:drug effects*
chemical_list: D004232:Diuretics; D004077:Digoxin