The short-term effects of digoxin in patients with right ventricular dysfunction from pulmonary hypertension.
OBJECTIVE
Studies on the effects of digoxin in patients with right ventricular failure and normal left ventricular function have not been performed. We evaluated the short-term effects of digoxin administration in patients with primary pulmonary hypertension on hemodynamics, neurohormones, and baroreceptor responsiveness.


METHODS
This was a prospective study with patients serving as their own controls.


METHODS
University Hospital Intensive Care Unit with central monitoring.


METHODS
Seventeen patients with primary pulmonary hypertension and symptomatic heart failure were enrolled.


METHODS
Following baseline hemodynamics, neurohormonal samples were drawn and the heart rate response to change in blood pressure following a challenge of phenylephrine and nitroprusside were recorded. One mg of intravenous digoxin was given and the measurements repeated after 2 hours.


RESULTS
Following digoxin there was a significant increase in cardiac output (3.49+/-1.2 to 3.81+/-1.2 L/min., p=0.028), a significant fall in norepinephrine (680+/-89 to 580+/-85 pg/ml, p=.013), and a significant increase in atrial natriuretic peptide (311+/-44 to 421+/-9 pg/ml, p=0.01). All of the patients had changes in heart rate and blood pressure following phenylephrine and nitroprusside challenge, but there was no significant difference in the change in heart rate response to change in blood pressure when rechallenged after digoxin treatment.


CONCLUSIONS
Digoxin produces a modest increase in cardiac output in patients with pulmonary hypertension and right ventricular failure, as well as a significant reduction in circulating norepinephrine. No detectable effects of digoxin on baroreceptor responsiveness were apparent. The use of digoxin in pulmonary hypertension is warranted.
Rich
S
S
The Rush Heart Institute, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612-3824, USA. srich@rpslmc.edu
Seidlitz
M
M
Dodin
E
E
Osimani
D
D
Judd
D
D
Genthner
D
D
McLaughlin
V
V
Francis
G
G
D000328:Adult; D009320:Atrial Natriuretic Factor / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011311:Pressoreceptors / Q000187:drug effects; D011446:Prospective Studies; D011660:Pulmonary Heart Disease / Q000188:drug therapy / Q000503:physiopathology; D012083:Renin / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D002316:Cardiotonic Agents; D004077:Digoxin; D009320:Atrial Natriuretic Factor; D012083:Renin; D009638:Norepinephrine