Newton G E, Tong J H, Schofield A M, Baines A D, Floras J S, Parker J D
Department of Medicine, Division of Cardiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1996 Jul;28(1):155-61. doi: 10.1016/0735-1097(96)00120-9.
This study evaluated the effect of digoxin on cardiac sympathetic activity in patients with congestive heart failure.
Digoxin favorably alters autonomic tone in heart failure. Whether it reduces cardiac sympathetic drive in the setting of heart failure is unknown.
Digoxin (0.25 mg intravenously) was administered to 12 patients with severe heart failure and elevated left ventricular end-diastolic pressure (> 14 mm Hg, Group A), 5 patients with less severe heart failure who had normal left ventricular end-diastolic pressure (> 14 mm Hg, Group B) and 6 patients with normal ventricular function. Seven additional patients with heart failure were studied as a time control group. Cardiac and total body norepinephrine spillover, systemic arterial pressure, left ventricular filling pressure and peak positive first derivative of left ventricular pressure were all assessed before and 30 min after administration of digoxin.
In Group A there were no changes in hemodynamic variables or total body norepinephrine spillover after digoxin administration; however, there was a significant reduction in cardiac norepinephrine spillover (263 +/- 70 to 218 +/- 62 pmol/min, mean +/- SEM, p < 0.001). In contrast, in Group B, digoxin caused a significant increase in cardiac norepinephrine spillover that was not associated with any hemodynamic changes or a change in total body spillover. There were no hemodynamic changes or a change in total body spillover. There were no hemodynamic or spillover changes in the time control or normal ventricular function group.
Digoxin, in the absence of detectable inotropic or hemodynamic effects, caused a reduction in cardiac norepinephrine spillover in patients with heart failure who had elevated filling pressures. This finding suggests a potentially beneficial primary autonomic action of digoxin in patients with severe heart failure.
本研究评估了地高辛对充血性心力衰竭患者心脏交感神经活动的影响。
地高辛可改善心力衰竭患者的自主神经张力。在心力衰竭情况下它是否能降低心脏交感神经驱动尚不清楚。
对12例严重心力衰竭且左心室舒张末期压力升高（>14 mmHg，A组）、5例左心室舒张末期压力正常（>14 mmHg）的轻度心力衰竭患者（B组）和6例心室功能正常的患者静脉注射地高辛（0.25 mg）。另外7例心力衰竭患者作为时间对照组进行研究。在注射地高辛前及注射后30分钟评估心脏和全身去甲肾上腺素溢出、体循环动脉压、左心室充盈压以及左心室压力的最大正向一阶导数。
A组注射地高辛后血流动力学变量及全身去甲肾上腺素溢出无变化；然而，心脏去甲肾上腺素溢出显著降低（从263±70降至218±62 pmol/min，均值±标准误，p<0.001）。相比之下，B组中，地高辛导致心脏去甲肾上腺素溢出显著增加，这与任何血流动力学变化或全身溢出变化均无关。时间对照组和心室功能正常组无血流动力学变化或溢出变化。
在未检测到正性肌力或血流动力学效应的情况下，地高辛使左心室充盈压升高的心力衰竭患者的心脏去甲肾上腺素溢出降低。这一发现提示地高辛在严重心力衰竭患者中可能具有潜在有益的原发性自主神经作用。
