Potential effects of digoxin on long-term renal and clinical outcomes in chronic heart failure.
Potential effects of digoxin on long-term renal and clinical outcomes in chronic heart failure.
复制标题
DOI：
10.1016/j.cardfail.2013.03.002
复制
发表时间：
2013-05
影响因子：
6
通讯作者：
Coca, Steven G.
中科院分区：
文献类型：
--
作者：
Testani, Jeffrey M.;Brisco, Meredith A.;Tang, W. H. Wilson;Kimmel, Stephen E.;Tiku-Owens, Anjali;Forfia, Paul R.;Coca, Steven G.
已知洋地黄糖苷可改善导致心力衰竭（HF）诱导的肾功能不全（RD）的血液动力学和神经激素紊乱。本研究的目的是确定随机分配至地高辛组是否与肾功能（IRF）改善相关，并评价地高辛诱导的IRF患者是否改善了临床结局。研究了洋地黄研究组数据集中具有方案驱动的12个月血清肌酐水平的患者（在中心实验室进行，n=980）。IRF定义为随机化后估计肾小球滤过率（eGFR）增加≥ 20%。15.5%的人群发生IRF（eGFR平均改善34.5 ± 15.4%），在随机分配至地高辛组的患者中更常见（校正OR=1.6，p=0.02）。在无IRF的患者中，地高辛与死亡或住院率降低无关（校正HR=0.96，95% CI 0.8-1.2，p=0.67）。然而，在IRF组中，地高辛与无住院生存期显著改善相关（校正HR=0.49，95% CI 0.3-0.8，p=0.006，p相互作用=0.026）。在DIG试验的这个子集中，地高辛与肾功能的长期改善相关，并且在显示这种有利的肾应答的患者中，死亡或住院率降低。需要进一步的研究来证实这些假设产生的结果。
Digitalis glycosides are known to improve the hemodynamic and neurohormonal perturbations that contribute to heart failure (HF) induced renal dysfunction (RD). The objective of this study was to determine if randomization to digoxin is associated with improvement in renal function (IRF) and to evaluate if patients with digoxin induced IRF have improved clinical outcomes. Patients in the Digitalis Investigation Group dataset with protocol driven 12 month serum creatinine levels (performed in a central laboratory, n=980) were studied. IRF was defined as a post randomization ≥ 20% increase in estimated glomerular filtration rate (eGFR). IRF occurred in 15.5% of the population (mean improvement in eGFR 34.5 ± 15.4%) and was more common in patients randomized to digoxin (adjusted OR=1.6, p=0.02). In patients without IRF, digoxin was not associated with reduced death or hospitalization (adjusted HR=0.96, 95% CI 0.8–1.2, p=0.67). However, in the group with IRF, digoxin was associated with substantially improved hospitalization free survival (adjusted HR=0.49, 95% CI 0.3–0.8, p=0.006, p interaction=0.026). In this subset of the DIG trial, digoxin was associated with long term improvement in kidney function, and in patients demonstrating this favorable renal response, reduction in death or hospitalization. Additional research is necessary to confirm these hypothesis generating findings.
登录
查看更多内容
影响因子：
6
作者：
Heywood, J. Thomas;Fonarow, Gregg C.;Wynne, Janet
通讯作者：
Wynne, Janet
影响因子：
158.5
作者：
Massie, Barry M.;O'Connor, Christopher M.;Dittrich, Howard C.
通讯作者：
Dittrich, Howard C.
DOI：
10.1080/17482940902883246
发表时间：
2009-01-01
期刊：
Acute cardiac care
影响因子：
--
作者：
Gheorghiade, Mihai;Harinstein, Matthew E;Filippatos, Gerasimos S
通讯作者：
Filippatos, Gerasimos S
影响因子：
1.9
作者：
Testani, Jeffrey M.;McCauley, Brian D.;Shannon, Richard P.
通讯作者：
Shannon, Richard P.
影响因子：
6
作者：
Damman, Kevin;Navis, Gerjan;Hillege, Hans L.
通讯作者：
Hillege, Hans L.