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Digitalis in heart failure! Still applicable?

Digitalis bei Herzinsuffizienz! Noch indiziert?

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Zusammenfassung

Bei Herzinsuffizienz und tachyarrhythmischem Vorhofflimmern besteht zur Kammerfrequenzkontrolle eine Indikation zu einer Herzglykosidtherapie meist in Kombination mit einem Betablocker. Derzeit wird jedoch kontrovers diskutiert, ob Patienten mit systolischer Herzinsuffizienz und Sinusrhythmus Digitalis erhalten sollten. Speziell bestehen Bedenken, dass bei Frauen unter Herzglykosiden eine Übersterblichkeit auftreten könnte. Retrospektive Subgruppenanalysen weisen jedoch nicht auf einen geschlechter-spezifischen Unterschied der Effektivität oder Nebenwirkungen einer Herzglykosid-Therapie hin. Vielmehr scheint bei der Digitalis-Therapie herzinsuffizienter Patienten die neurohumorale Modulation, die bereits bei niedrigen Serumkonzentration voll ausgeprägt ist, der eigentlich günstige Effekt zu sein, während erst höhere Serumspiegel mit einer erhöhten Sterblichkeit assoziiert sind. Dementsprechend sollte bei persistierenden Symptomen unter einer optimalen Medikation mit ACE-Hemmer, Betablocker und Diuretikum auch im Sinusrhythmus unabhängig vom Geschlecht eine Herzglykosidtherapie eingeleitet werden. Dabei sind jedoch niedrige Herzglykosid-Serumspiegel, nach derzeitigem Kenntnisstand für Digoxin zwischen 0,5 bis 0,8 ng/ml anzustreben.

Summary

In patients with heart failure and atrial fibrillation cardiac glycosides, generally in combination with beta-blockers, are indicated to control ventricular rate. In systolic heart failure and sinus rhythm, however, the use of digitalis continues to be debated. There are special concerns that cardiac glycosides might lead to an increased mortality rate in women. Retrospective analyses, however, do not indicate any sex-based differences in the effectiveness of cardiac glycosides. Beneficial effects of cardiac glycosides in heart failure seem to be related to the attenuation of sympathetic activation and neurohumoral alterations, which is already obtained at low digoxin serum concentrations, while high serum levels are associated with increased mortality. Therefore, in patients with sinus rhythm who remain symptomatic under an optimized therapy with ACE inhibitors, beta-blockers and diuretics in addition to digitalis should be considered regardless of the gender. However, target serum digoxin concentrations should be low in a range of 0.5 to 0.8 ng/ml.

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  1. Department of Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    U. C. Hoppe & E. Erdmann

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  1. U. C. Hoppe
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  2. E. Erdmann
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Correspondence to U. C. Hoppe.

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Hoppe, U.C., Erdmann, E. Digitalis in heart failure! Still applicable?. ZS Kardiologie 94, 307–311 (2005). https://doi.org/10.1007/s00392-005-0219-0

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  • DOI: https://doi.org/10.1007/s00392-005-0219-0

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