Sullivan M, Atwood J E, Myers J, Feuer J, Hall P, Kellerman B, Forbes S, Froelicher V
Cardiology Department, Long Beach Veterans Administration Medical Center, California 90822.
J Am Coll Cardiol. 1989 Apr;13(5):1138-43. doi: 10.1016/0735-1097(89)90276-3.
Failure to objectively assess the effect of digitalis on exercise capacity has resulted in controversy regarding its use in patients with chronic congestive heart failure. To clarify this situation, maximal treadmill testing with respiratory gas exchange analysis was performed on 11 patients (mean age 57 +/- 9 years) with chronic congestive heart failure with and without digoxin therapy. Ten of the 11 had a consistent third sound gallop, and the mean ejection fraction of the group was 24 +/- 10%. Rest heart rate was significantly higher (91 +/- 16 versus 102 +/- 16 beats/min; p less than 0.05) and rest systolic blood pressure was significantly reduced in the absence of digoxin (130 +/- 23 versus 121 +/- 15 mm Hg; p less than 0.05). No differences in heart rate or blood pressure were observed during exercise. Significant increases in ventilatory oxygen uptake were observed with digoxin submaximally (3.0 mph, 0% grade), at the gas exchange anaerobic threshold and at maximal exercise (mean increase of 2.6 ml/kg per min; p less than 0.02). An improvement in the estimated ratio of ventilatory dead space to tidal volume (VD/VT), an index of physiologic efficiency, occurred throughout exercise during digoxin therapy, and there was a significant negative correlation between the change in maximal oxygen uptake and change in maximal estimated VD/VT (r = -0.63; p less than 0.05). Thus, digoxin therapy is associated with a significant improvement in exercise capacity in patients with chronic heart failure, most likely due to an improved matching of ventilation to perfusion.
未能客观评估洋地黄对运动能力的影响，导致了其在慢性充血性心力衰竭患者中应用的争议。为了澄清这种情况，对11例（平均年龄57±9岁）慢性充血性心力衰竭患者在使用和未使用地高辛治疗的情况下进行了最大运动平板试验及呼吸气体交换分析。11例患者中有10例有持续性第三心音奔马律，该组平均射血分数为24±10%。静息心率在未使用地高辛时显著更高（91±16次/分钟对102±16次/分钟；p<0.05），静息收缩压在未使用地高辛时显著降低（130±23毫米汞柱对121±15毫米汞柱；p<0.05）。运动期间未观察到心率或血压的差异。在次最大运动（3.0英里/小时，0%坡度）、气体交换无氧阈和最大运动时，地高辛可显著增加通气摄氧量（平均增加2.6毫升/千克每分钟；p<0.02）。地高辛治疗期间，在整个运动过程中，通气死腔与潮气量之比（VD/VT）这一生理效率指标有所改善，最大摄氧量变化与最大估计VD/VT变化之间存在显著负相关（r=-0.63；p<0.05）。因此，地高辛治疗可使慢性心力衰竭患者的运动能力显著改善，很可能是由于通气与灌注的匹配得到改善。
