Digoxin therapy for cor pulmonale: A systematic review

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• 作者：Wissam Alajaji ; MD^a ; Atallah Baydoun ; MD^c ; ^d ; Sadeer G. Al-Kindi ; MD^b ; ^d ; Leslie Henry ; M.S.L.S^e ; Mazen A. Hanna ; MD^f ; Guilherme H. Oliveira ; MD^d ; ^g ; ^{guilherme.oliveira@uhhospitals.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Right heart failure ; Pulmonary hypertension ; Chronic obstructive pulmonary disease digoxin ; Mortality ; Right ventricular function
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 November 2016
• 年：2016
• 卷：223
• 期：Complete
• 页码：320-324
• 全文大小：310 K

文摘

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.