Gheorghiade M, Beller G A
Am J Cardiol. 1983 May 1;51(8):1243-50. doi: 10.1016/0002-9149(83)90293-x.
To evaluate the importance of oral maintenance digoxin therapy in chronic congestive heart failure (CHF), 24 patients in sinus rhythm on maintenance digoxin for documented CHF were studied prospectively on and off the drug. The average duration of therapy was 39 months (range 2 to 180). All 24 patients had documented coronary artery disease (CAD): 22 were in New York Heart Association functional class III and 2 in class II. Twenty-one patients (88%) were receiving diuretic or vasodilator therapy, or both, before digoxin discontinuance. At 1 month off digoxin and with no increase in doses of other medications excepting minor increases in antianginal therapy in 2 patients, no difference was observed in the group as a whole in symptoms, resting heart rate, arterial blood pressure, physical findings, weight, cardiothoracic ratio, radiographic signs of pulmonary congestion, radionuclide left ventricular ejection fraction (LVEF), duration of symptom-limited treadmill exercise (14 patients), or CHF score, compared with evaluation during maintenance digoxin therapy. Similar results were obtained in a subgroup of 9 patients with a resting LVEF less than 0.35 (0.27 +/- 0.02; mean +/- standard error of the mean). Six patients had a decrease and 5 patients an increase in LVEF of greater than or equal to 0.05 units after cessation of digoxin. Off digoxin, the CHF score increased by only 1 point in 2 patients, but also decreased in 2 patients. Thus, in this study population comprised of patients with CAD with documented CHF, most of whom were receiving diuretics or vasodilators, or both, digoxin withdrawal had no adverse clinical or hemodynamic effects.
为评估口服维持量地高辛疗法在慢性充血性心力衰竭（CHF）中的重要性，对24例因确诊CHF而接受维持量地高辛治疗且心律为窦性的患者进行了前瞻性研究，观察其用药及停药情况。平均治疗时长为39个月（范围为2至180个月）。所有24例患者均确诊患有冠状动脉疾病（CAD）：22例处于纽约心脏协会心功能Ⅲ级，2例处于Ⅱ级。21例患者（88%）在停用洋地黄之前接受利尿剂或血管扩张剂治疗，或两者皆用。在停用地高辛1个月时，除2例患者抗心绞痛治疗剂量略有增加外，其他药物剂量均未增加，与维持地高辛治疗期间的评估相比，整个组在症状、静息心率、动脉血压、体格检查结果、体重、心胸比率、肺充血的影像学征象、放射性核素左心室射血分数（LVEF）、症状限制的平板运动时长（14例患者）或CHF评分方面均未观察到差异。在静息LVEF小于0.35（0.27±0.02；均值±均值标准误差）的9例患者亚组中也得到了类似结果。停用地高辛后，6例患者的LVEF下降，5例患者的LVEF升高幅度大于或等于0.05单位。停用地高辛后，2例患者的CHF评分仅增加1分，但也有2例患者的CHF评分下降。因此，在这个由确诊CHF的CAD患者组成的研究人群中，大多数患者正在接受利尿剂或血管扩张剂治疗，或两者皆用，停用地高辛并未产生不良临床或血流动力学影响。
