title: Digoxin therapy for cor pulmonale: A systematic review.
abstract: OBJECTIVE
  Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of this study is to conduct a systematic review of the literature to assess the relative benefits and harms of digoxin therapy in patients with RV failure.
  
  
  METHODS
  We performed a literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) on Nov. 4, 2014. We did not use publication type, period or language restrictions to the search strategy. Exclusions included: trials that excluded patients with RV failure, included patients requiring mechanical or intravenous inotropic support, review papers and case reports. The primary outcome was long-term efficacy outcomes of digoxin in right heart failure. Two reviewers screened titles and abstracts of identified citations independently and in duplication using calibration exercises and standardized screening forms.
  
  
  RESULTS
  The search strategy identified 4097 citations, and 4 studies were included in this analysis (n=76 patients). Of the four studies, two assessed improvements in RVEF, two studies compared exercise capacity indexes, and one assessed symptoms with digoxin compared with placebo. No study assessed mortality outcomes. Overall, there was no statistically significant improvement in RVEF, exercise capacity, NYHA class, heart failure score, or body weight.
  
  
  CONCLUSIONS
  There are few studies evaluating Digitalis use for RV failure, which are limited to patients with cor pulmonale. In these patients, Digitalis use provides no improvement in RVEF, exercise capacity, or NYHA class. Randomized clinical trials are needed to address this question.
authors.affiliation: Summa Cardiovascular Institute, Summa Health System, Akron, OH, United States.
authors.forename: Wissam
authors.initials: W
authors.lastname: Alajaji
authors.affiliation: Louis Stokes VA Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States.
authors.forename: Atallah
authors.initials: A
authors.lastname: Baydoun
authors.affiliation: Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States.
authors.forename: Sadeer G
authors.initials: SG
authors.lastname: Al-Kindi
authors.affiliation: University Hospitals Case Medical Center Core Library, Cleveland, OH, United States.
authors.forename: Leslie
authors.initials: L
authors.lastname: Henry
authors.affiliation: Division of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States.
authors.forename: Mazen A
authors.initials: MA
authors.lastname: Hanna
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, United States; Division of Cardiovascular Medicine, Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, United States. Electronic address: guilherme.oliveira@uhhospitals.org.
authors.forename: Guilherme H
authors.initials: GH
authors.lastname: Oliveira
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use*; D006801:Humans; D011660:Pulmonary Heart Disease / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin
keywords: Chronic obstructive pulmonary disease digoxin; Mortality; Pulmonary hypertension; Right heart failure; Right ventricular function