Bouchahda Nidhal, Bader Mouna, Najjar Aymen, Mghaieth Zghal Fathia, Sassi Ghada, Mourali Mohamed Sami, Ben Messaoud Mejdi
Cardiology A Department, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, University of Monastir, Monastir University, Rue du 1er juin 1955, 5000, Monastir, Tunisia.
Department of Cardiological Investigations and Resuscitation, Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
Am J Cardiovasc Drugs. 2025 May;25(3):411-418. doi: 10.1007/s40256-024-00705-w. Epub 2024 Dec 26.
BACKGROUND AND OBJECTIVE: Left atrial strain (LAS) has prognostic value in patients with atrial fibrillation (AF). Consequently, therapies that improve LAS may help reduce AF-related adverse cardiac events. We aimed to compare how digoxin and bisoprolol modulate LAS in patients with AF being treated with rate control.
This was a bicentric randomized controlled trial. Patients with AF, naïve to beta-blockers and digoxin, and scheduled for treatment with a rate control strategy were randomized to receive oral bisoprolol 5-10 mg daily or digoxin 0.25 mg daily. The primary aim was to compare the change in peak LAS before and after 30 days of treatment between the two groups.
A total of 60 patients, equally distributed between the two groups, completed the trial. By day 30, there was no significant difference in global peak LAS between the groups. However, when analyzed separately, the two-chamber view showed a significantly higher peak LAS in the digoxin group than in the BB group (mean 7.5 ± standard deviation 3.2% vs. 5.9 ± 3.4%; p = 0.004). Similarly, the four-chamber view also showed a higher peak LAS in the digoxin group (7.2 ± 3.6% vs. 6.4 ± 3.8%; p = 0.047). Considering the entire LAS curve rather than solely the peak value, digoxin significantly increased all LAS curves. In the global and four-chamber view, the digoxin maximum effect occurred significantly earlier than the peak of the LAS curve (p < 0.001). This effect remained constant over the cardiac cycle in the two-chamber curve (p < 0.001).
Our findings suggest that, in patients with rate-controlled AF, digoxin positively modulates LAS when compared with bisoprolol.
NCT05540600, https://clinicaltrials.gov .
背景与目的：左心房应变（LAS）对房颤（AF）患者具有预后价值。因此，改善LAS的治疗方法可能有助于减少与房颤相关的不良心脏事件。我们旨在比较地高辛和比索洛尔对接受心率控制治疗的房颤患者LAS的调节作用。
这是一项双中心随机对照试验。未使用过β受体阻滞剂和地高辛且计划采用心率控制策略治疗的房颤患者被随机分为两组，分别每日口服5 - 10毫克比索洛尔或0.25毫克地高辛。主要目的是比较两组治疗30天后LAS峰值的变化。
共有60名患者完成试验，两组各30名。到第30天时，两组的整体LAS峰值无显著差异。然而，单独分析时，双腔视图显示地高辛组的LAS峰值显著高于β受体阻滞剂组（平均值7.5±标准差3.2% vs. 5.9±3.4%；p = 0.004）。同样，四腔视图也显示地高辛组的LAS峰值更高（7.2±3.6% vs. 6.4±3.8%；p = 0.047）。考虑整个LAS曲线而非仅峰值，地高辛显著增加了所有LAS曲线。在整体和四腔视图中，地高辛的最大作用显著早于LAS曲线的峰值（p < 0.001）。在双腔曲线的心动周期中，这种作用保持恒定（p < 0.001）。
我们的研究结果表明，在接受心率控制的房颤患者中，与比索洛尔相比，地高辛对LAS具有正向调节作用。
NCT05540600，https://clinicaltrials.gov 。
