The view that digitalis clinically benefits patients with heart failure and sinus rhythm lacks support from a well-controlled study. Using a randomized, double-blind, crossover protocol, we compared the effects of oral digoxin and placebo on the clinical courses of 25 outpatients without atrial fibrillation. According to a clinicoradiographic scoring system, the severity of heart failure was reduced by digoxin in 14 patients; in nine of these 14, improvement was confirmed by repeated trials (five patients) or right-heart catheterization (four patients). The other 11 patients had no detectable improvement from digoxin. Patients who responded to digoxin had more chronic and more severe heart failure, greater left ventricular dilation and ejection-fraction depression, and a third heart sound. Multivariate analysis showed that the third heart sound was the strongest correlate of the response to digoxin (P less than 0.0001). These data suggest that long-term digoxin therapy is clinically beneficial in patients with heart failure unaccompanied by atrial fibrillation whose failure persists despite diuretic treatment and who have a third heart sound.
This article has been cited by other articles:
Endorsed by the European Society of Intensive Care, , Authors/Task Force Members, , Nieminen, M. S., Bohm, M., Cowie, M. R., Drexler, H., Filippatos, G. S., Jondeau, G., Hasin, Y., Lopez-Sendon, J., Mebazaa, A., Metra, M., Rhodes, A., Swedberg, K., ESC Committee for Practice Guidelines, , Priori, S. G., Garcia, M. A. A., Blanc, J.-J., Budaj, A., Cowie, M. R, Dean, V., Deckers, J., Burgos, E. F., Lekakis, J., Lindahl, B., Mazzotta, G., Morais, J., Oto, A., Smiseth, O. A., Document Reviewers, , Garcia, M. A. A., Dickstein, K., Albuquerque, A., Conthe, P., Crespo-Leiro, M., Ferrari, R., Follath, F., Gavazzi, A., Janssens, U., Komajda, M., Morais, J., Moreno, R., Singer, M., Singh, S., Tendera, M., Thygesen, K.
(2005). Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J
26: 384-416
[Full Text]
Rahimtoola, S. H.
(2004). Digitalis Therapy for Patients in Clinical Heart Failure. Circulation
109: 2942-2946
[Full Text]
Gheorghiade, M., Gattis, W. A., O'Connor, C. M., Adams, K. F. Jr, Elkayam, U., Barbagelata, A., Ghali, J. K., Benza, R. L., McGrew, F. A., Klapholz, M., Ouyang, J., Orlandi, C.
(2004). Effects of Tolvaptan, a Vasopressin Antagonist, in Patients Hospitalized With Worsening Heart Failure: A Randomized Controlled Trial. JAMA
291: 1963-1971
[Abstract][Full Text]
Cuffe, M. S., Califf, R. M., Adams, K. F. Jr, Benza, R., Bourge, R., Colucci, W. S., Massie, B. M., O'Connor, C. M., Pina, I., Quigg, R., Silver, M. A., Gheorghiade, M., for the Outcomes of a Prospective Trial of Intrave,
(2002). Short-term Intravenous Milrinone for Acute Exacerbation of Chronic Heart Failure: A Randomized Controlled Trial. JAMA
287: 1541-1547
[Abstract][Full Text]
Di Lenarda, A., Sabbadini, G., Salvatore, L., Sinagra, G., Mestroni, L., Pinamonti, B., Gregori, D., Ciani, F., Muzzi, A., Klugmann, S., Camerini, F., The Heart-Muscle Disease Study Group,
(1999). Long-term effects of carvedilol in idiopathic dilated cardiomyopathy with persistent left ventricular dysfunction despite chronic metoprolol. J Am Coll Cardiol
33: 1926-1934
[Abstract][Full Text]
O'Keeffe, S T, Lye, M, Donnellan, C, Carmichael, D N
(1998). Reproducibility and responsiveness of quality of life assessment and six minute walk test in elderly heart failure patients. Heart
80: 377-382
[Abstract][Full Text]
Abraham, W. T.
(1998). Pharmacologic Management of Chronic Heart Failure: A Review. SEMIN CARDIOTHORAC VASC ANESTH
2: 168-190
[Abstract]
Sullebarger, J. T., D'Ambra, P. M., Clark, L. C., Thanikarry, L., Fontanet, H. L.
(1998). Effect of Digoxin on Ventricular Remodeling and Responsiveness of {beta}-Adrenoceptors in Chronic Volume Overload. J CARDIOVASC PHARMACOL THER
3: 281-290
[Abstract]
Daggubati, S., Parks, J. R, Overton, R. M, Cintron, G., Schocken, D. D, Vesely, D. L
(1997). Adrenomedullin, endothelin, neuropeptide Y, atrial, brain, and C-natriuretic prohormone peptides compared as early heart failure indicators. Cardiovasc Res
36: 246-255
[Abstract][Full Text]
Packer, M.
(1997). End of the Oldest Controversy in Medicine -- Are We Ready to Conclude the Debate on Digitalis?. NEJM
336: 575-576
[Full Text]
Tavel, M. E.
(1996). Cardiac Auscultation : A Glorious Past—But Does It Have a Future?. Circulation
93: 1250-1253
[Full Text]
COMMITTEE MEMBERS, , WILLIAMS, J. F. Jr, BRISTOW, M. R., FOWLER, M. B., FRANCIS, G. S., GARSON, A. Jr, GERSH, B. J., HAMMER, D. F., HLATKY, M. A., LEIER, C. V., PACKER, M., PITT, B., ULLYOT, D. J., WEXLER, L. F., WINTERS, W. L. Jr, TASK FORCE MEMBERS, , RITCHIE, J. L., CHEITLIN, M. D., EAGLE, K. A., GARDNER, T. J., GARSON, A. Jr, GIBBONS, R. J., LEWIS, R. P., O'ROURKE, R. A., RYAN, T. J.
(1995). Guidelines for the Evaluation and Management of Heart Failure : Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure). Circulation
92: 2764-2784
[Full Text]
Gheorghiade, M., B. Hall, V., Jacobsen, G., Alam, M., Rosman, H., Goldstein, S.
(1995). Effects of Increasing Maintenance Dose of Digoxin on Left Ventricular Function and Neurohormones in Patients With Chronic Heart Failure Treated With Diuretics and Angiotensin-Converting Enzyme Inhibitors. Circulation
92: 1801-1807
[Abstract][Full Text]
Packer, M., Gheorghiade, M., Young, J. B., Costantini, P. J., Adams, K. F., Cody, R. J., Smith, L. K., Van Voorhees, L., Gourley, L. A., Jolly, M. K., The RADIANCE Study,
(1993). Withdrawal of Digoxin from Patients with Chronic Heart Failure Treated with Angiotensin-Converting-Enzyme Inhibitors. NEJM
329: 1-7
[Abstract][Full Text]
Previous
