The effect of chronic digitalization on pump function in systolic heart failure.
BACKGROUND
Short- and intermediate-term use of cardiac glycosides promotes inotropy and improves the ejection fraction in systolic heart failure.


OBJECTIVE
To determine whether chronic digitalization alters left ventricular function and performance.


METHODS
Eighty patients with mild-to-moderate systolic heart failure (baseline ejection fraction < or =45%) participated from our institution in a multi-center, chronic, randomized, double-blind study of digitalis vs. placebo. Of the 40 survivors, 38 (20 allocated to the digitalis arm and 18 to the placebo arm) were evaluated at the end of follow-up (mean, 48.4 months). Left ventricular systolic function was assessed by both nuclear ventriculography and echocardiography. The ejection fraction was measured scintigraphically, while the ventricular volumes were computed echocardiographically.


RESULTS
The groups did not differ, at baseline or end-of-study, with respect to the ejection fraction and the loading conditions (arterial pressure, ventricular volumes and heart rate) by either intention-to-treat or actual-treatment-received analysis. Over the course of the trial, the digitalis arm exhibited no significant increase in the use of diuretics (18%, P=0.33), in distinction from the placebo group (78%, P=0.004), and a longer stay on study drug among those patients who withdrew from double-blind treatment (28.6 vs. 11.4 months, P=0.01).


CONCLUSIONS
Following chronic use of digitalis for mild-to-moderate heart failure, cross-sectional comparison with a control group from the same inception cohort showed no appreciable difference in systolic function or performance. Thus, the suggested clinical benefit cannot be explained by an inotropic effect.
Hassapoyannes
C A
CA
The Divisions of Cardiology, Departments of Medicine, William Jennings Bryan Dorn Veterans Affairs Medical Center, 6439 Garners Ferry Road, Columbia, SC 29209-1639, USA. cahass@aol.com
Easterling
B M
BM
Chavda
K
K
Chavda
K K
KK
Movahed
M R
MR
Welch
G W
GW
D000368:Aged; D000465:Algorithms; D002301:Cardiac Glycosides / Q000627:therapeutic use*; D004070:Digitalis / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013599:Systole / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects*
D002301:Cardiac Glycosides