Is digoxin really important in treatment of compensated heart failure?. A placebo-controlled crossover study in patients with sinus rhythm

To assess the efficacy of digitalis in patients with chronic clinically compensated congestive heart failure and normal sinus rhythm, we performed a double-blind crossover study with digoxin and placebo in 30 consecutive outpatients fullfilling these criteria; serum digoxin levels, clinical symptoms and signs, and objective indexes of cardiac function were monitored. No patient's clinical condition deteriorated during three months of placebo administration. Discontinuation of digoxin resulted in a small increase in echocardiographically determined resting left ventricular end-diastolic dimension (1.8 ± 0.6 mm, p < 0.001) and a similar decrease in velocity of circumferential fiber shortening (-0.08 ± 0.04 circ/sec, p < 0.05) from the corresponding values of 55.8 ± 2.3 mm and 0.90 ± 0.08 circ/sec during digitalis therapy. Resting left ventricular ejection time and preejection period were prolonged by digoxin withdrawal. Maximal exercise capacity was unchanged. No clinical exacerbation of heart failure attributable to digitalis withdrawal occurred over a follow-up period averaging 19 months. The results indicate that long-term digoxin therapy has only a minor effect on cardiac performance that is without apparent clinical importance in a representative population of ambulatory patients treated with cardiac glycosides.