Abbasi Muhannad Aboud, Stoller Douglas A, Lyden Elizabeth, Lowes Brian D, Zolty Ronald, Lundgren Scott W
Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
Int J Artif Organs. 2022 Nov;45(11):919-926. doi: 10.1177/03913988221112684. Epub 2022 Aug 9.
We aimed to assess the impact of digoxin use following left ventricular assist device (LVAD) implantation on clinical outcomes.
Patients implanted with continuous flow LVADs at a single academic medical center and survived to initial hospital discharge were included in the analysis ( = 346). Clinical events were captured at a maximum of 2 years of follow up. Digoxin use was defined as 30-day continuous use post-LVAD. Negative binomial regression and Kaplan-Meier method were used to assess the association between digoxin use and clinical outcomes.
Mean age of the cohort was 56 years (±13) and 23% (79/346) were female sex. Digoxin was used in 144 patients (41.6%) for a median of 268 days (IQR 154, 616). Digoxin use was associated with a significant reduction in cumulative incidence of gastrointestinal bleeding (GIB) (15% vs 26%, = 0.004). After adjusting for age, hypertension, post-operative hemoglobin, RDW, potassium, and GFR, and use of angiotensin receptor/neprilysin inhibitor, there remained a significant 47% reduction in GIB incidence in patients treated with digoxin. There was no significant difference in cumulative incidence in right ventricular failure (RVF) between the two groups. There was no difference in overall 2-year survival between groups.
Digoxin use was associated with reduction in GIB events, but not in RVF or mortality. Further studies are needed to confirm these findings and to investigate optimal timing and patient population.
我们旨在评估左心室辅助装置（LVAD）植入后使用地高辛对临床结局的影响。
分析纳入了在单一学术医疗中心植入连续血流LVAD并存活至首次出院的患者（n = 346）。随访最长2年，记录临床事件。地高辛使用定义为LVAD植入后连续使用30天。采用负二项回归和Kaplan-Meier方法评估地高辛使用与临床结局之间的关联。
队列的平均年龄为56岁（±13），23%（79/346）为女性。144例患者（41.6%）使用了地高辛，中位使用时间为268天（四分位间距154, 616）。使用地高辛与胃肠道出血（GIB）累积发生率显著降低相关（15%对26%，P = 0.004）。在调整年龄（岁）、高血压、术后血红蛋白、红细胞分布宽度、钾、肾小球滤过率以及血管紧张素受体/脑啡肽酶抑制剂的使用情况后，使用地高辛的患者GIB发生率仍显著降低47%。两组右心室衰竭（RVF）累积发生率差异无统计学意义。两组2年总生存率无差异。
使用地高辛与GIB事件减少相关，但与RVF或死亡率无关。需要进一步研究以证实这些发现，并探讨最佳时机和患者群体。
