K-strophanthin or digoxin were added to diuretics (all cases) and vasodilators (most cases) for treating advanced congestive heart failure in 22 patients with dilated cardiomyopathy and sinus rhythm. K-strophanthin (0.125 mg intravenously) or digoxin (0.25 mg orally) were administered daily in two 3-month periods, during which vasodilators and diuretics were kept constant and patients received one of the two digitalis preparations in a double-blind fashion, crossing over to the alternative preparation in the next period. Blindness was assured throughout the trial with a daily intravenous injection of 10 ml normal saline solution either containing K- strophanthin or not, and with daily oral administration of either placebo or active digoxin. At the end of the run-in period, 15 days after starting active preparations, and thereafter every month for the next 6 months, we evaluated left ventricular pump function at rest and patients' functional performance by a cardiopulmonary exercise test. At Day 15, cardiac index and ejection fraction at rest, compared with run-in, were significantly raised with both glycosides; during exercise while on K-strophanthin, peak oxygen consumption was augmented by 1.4 ml/min/kg (p <0.01) and oxygen consumption at anaerobic threshold by 2.2 ml/min/kg (p <0.01); corresponding variations on digoxin (-0.1 and +0.3, respectively) were not significant versus run-in. These patterns were duplicated at repeated tests during follow-up. In the entire population, means for oxygen consumption at peak exercise and at anaerobic threshold were raised from run-in values by 1.4 (p <0.01) and 2.2 ml/min/kg (p <0.01), respectively, after 3 months of K-strophanthin treatment, and by 0.0 and 0.1 ml/min/kg, respectively, after treatment with digoxin for the same period of time. Results were similar in nine patients when they were given digoxin intravenously (0.25 mg/day) for 1 week after having completed the trial with the oral digoxin preparation. These results indicate that K-strophanthin improved functional performance in patients with severe cardiac decompensation due to dilated cardiomyopathy; digoxin failed to provide the same results, independent of the drug sequence or the route of administration. The reasons for these differences are basically unknown and do not seem to be related only to changes in cardiac performance at rest, because both K-strophanthin and digoxin significantly and persistently raised cardiac output and ejection fraction at rest.
|Number of pages||6|
|Publication status||Published - 1994|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine