Rivinius Rasmus, Helmschrott Matthias, Ruhparwar Arjang, Rahm Ann-Kathrin, Darche Fabrice F, Thomas Dierk, Bruckner Tom, Ehlermann Philipp, Katus Hugo A, Doesch Andreas O
Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg.
Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg.
Ther Clin Risk Manag. 2017 Oct 13;13:1399-1407. doi: 10.2147/TCRM.S147062. eCollection 2017.
Digitalis therapy (digoxin or digitoxin) in patients with heart failure is subject to an ongoing debate. Recent data suggest an increased mortality in patients receiving digitalis. This study investigated the effects of chronic digitalis therapy prior to heart transplantation (HTX) on posttransplant outcomes.
This was a retrospective, observational, single-center study. It comprised 530 adult patients who were heart-transplanted at Heidelberg University Hospital between 1989 and 2012. Patients with digitalis prior to HTX (≥3 months) were compared to those without (no or <3 months of digitalis). Patients with digitalis were further subdivided into patients receiving digoxin or digitoxin. Primary outcomes were early posttransplant atrial fibrillation and mortality.
A total of 347 patients (65.5%) had digitalis before HTX. Of these, 180 received digoxin (51.9%) and 167 received digitoxin (48.1%). Patients with digitalis before HTX had a significantly lower 30-day (=0.0148) and 2-year (=0.0473) survival. There was no significant difference between digoxin and digitoxin in 30-day (=0.9466) or 2-year (=0.0723) survival. Multivariate analysis for posttransplant 30-day mortality showed pretransplant digitalis therapy as an independent risk factor (hazard ratio =2.097, CI: 1.036-4.248, =0.0397). Regarding atrial fibrillation in the early posttransplant period, there was neither a statistically significant difference between patients with and without digitalis (=0.1327) nor between patients with digoxin or digitoxin (=0.5867).
Digitalis in patients before HTX is an independent risk factor for increased posttransplant mortality.
心力衰竭患者使用洋地黄治疗（地高辛或洋地黄毒苷）一直存在争议。近期数据表明，接受洋地黄治疗的患者死亡率有所增加。本研究调查了心脏移植（HTX）前长期使用洋地黄治疗对移植后结局的影响。
这是一项回顾性、观察性单中心研究。研究对象为1989年至2012年间在海德堡大学医院接受心脏移植的530例成年患者。将HTX前使用洋地黄（≥3个月）的患者与未使用洋地黄（未使用或使用洋地黄<3个月）的患者进行比较。使用洋地黄的患者进一步细分为接受地高辛或洋地黄毒苷的患者。主要结局为移植后早期房颤和死亡率。
共有347例患者（65.5%）在HTX前使用洋地黄。其中，180例接受地高辛（51.9%），167例接受洋地黄毒苷（48.1%）。HTX前使用洋地黄的患者30天生存率（=0.0148）和2年生存率（=0.0473）显著较低。地高辛和洋地黄毒苷在30天生存率（=0.9466）或2年生存率（=0.0723）方面无显著差异。移植后30天死亡率的多因素分析显示，移植前洋地黄治疗是独立危险因素（风险比=2.097，CI：1.036 - 4.248，=0.0397）。关于移植后早期房颤，使用洋地黄和未使用洋地黄的患者之间（=0.1327）以及使用地高辛或洋地黄毒苷的患者之间（=0.5867）均无统计学显著差异。
HTX前患者使用洋地黄是移植后死亡率增加的独立危险因素。
