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European Journal of Heart Failure 2001 3(5):593-599; doi:10.1016/S1388-9842(01)00141-6
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© 2001 European Society of Cardiology

The effect of chronic digitalization on pump function in systolic heart failure

Constantine A. Hassapoyannes*, Bruce M. Easterling, Kiran Chavda, Krina K. Chavda, M. Reza Movahed and Gary W. Welch

The Divisions of Cardiology, Departments of Medicine, William Jennings Bryan Dorn Veterans Affairs Medical Center and the University of South Carolina School of Medicine Columbia, SC, USA

* Corresponding author. Division of Cardiology (111C), WJB Dorn VAMC, 6439 Garners Ferry Road, Columbia, SC 29209-1639, USA; Tel.: +1-803-776-4000, ext. 7142; fax: +1-803-695-7913. E-mail address: cahass{at}aol.com or hassapoyannes.c_a{at}columbia-sc.va.gov (C.A. Hassapoyannes)


  Abstract

Background: Short- and intermediate-term use of cardiac glycosides promotes inotropy and improves the ejection fraction in systolic heart failure.

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

Methods: Eighty patients with mild-to-moderate systolic heart failure (baseline ejection fraction ≤ 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).

Conclusion: 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.

Key Words: Digitalis • Heart failure • Congestive • Ventricular dysfunction, left • Systole

Received November 13, 2000; Revised December 28, 2000; Accepted February 12, 2001


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