EFFICACY OF DIGITALIS IN CONGESTIVE HEART FAILURE AND IN NORMAL SUBJECTS

我们之前在一项双盲交叉研究中表明，洋地黄 可以连续服用三个月而不会产生不良的临床影响 30例稳定型心脏病患者心脏大小和功能仅有轻微变化 充血性心力衰竭(CHF)和窦性心律。 评估维持性地高辛治疗改善运动的能力 稳定性充血性心力衰竭、收缩功能不全和窦性心动过缓患者的耐受性 节律，我们在12个这样的跑台上进行了最大运动试验 个体同时监测呼吸气体交换。没有区别 运动持续时间、最大耗氧量(VO2max)、最大心率 服用地高辛4周与服用安慰剂4周后出现换气。 在一项随机交叉研究中。在最大限度的直立自行车运动中， 然而，地高辛将射血分数从0.26增加到0.31，尽管 完全相同的运动耐力。 我们小组发起了一份调查问卷的开发工作 与不同大学的心脏病学专家一起采样 具有代表性的学术和执业内科医生团体 目前对其有效性和毒性的使用和了解 洋地黄总苷。在2704名受访者中，仅有利尿剂 被认为是治疗CHF的最佳初始疗法，50%的人认为洋地黄是最好的初始疗法 8%，33%的组合。三分之二的样本认为 洋地黄提高了运动耐量。因此，尽管越来越多的证据表明 洋地黄苷可以成功地从患者体内撤除 慢性稳定型心力衰竭，人们普遍认为这些药物是 对大多数充血性心力衰竭患者有效。

We have previously shown in a double-blind crossover study that digitalis could be discountinued for three months without adverse clinical effect and only minor changes in cardiac size and function in 30 subjects with stable congestive heart failure (CHF) and sinus rhythm. To assess the ability of maintenance digoxin therapy to improve exercise tolerance in patients with stable CHF, systolic dysfunction and sinus rhythm, we performed maximal treadmill exercise tests in 12 such individuals while monitoring respiratory gas exchange. No difference in exercise duratin, maximal oxygen consumption (VO2max), maximal heart rate, or ventilation was found after 4 weeks of digoxin versus 4 weeks of placebo in a randomized crossover study. During maximal upright bicycle exercise, however, digoxin increased ejection fraction of .26 to .31 despite identical exercise tolerance. Our group has initiated the development of a questionnaire in conjunction with experts in cardiology at different universities to sample representative groups of academic and practicing physicians in their current use and understanding of the effectiveness and toxicity of digitalis glycosides. Among 2704 questionnaire respondents diuretics alone were considered the best initial therapy for CHF in 50%, digitalis alone by 8% and the combination in 33%. Two thirds of the sample felt that digitalis improved exercise tolerance. Thus, despite growing evidence that digitalis glycosides can be successfully withdrawn from patients with chronic stable CHF, there is widespread belief that these drugs are effective in most CHF patients.