Version 1
: Received: 6 November 2023 / Approved: 7 November 2023 / Online: 7 November 2023 (14:18:16 CET)
How to cite:
Erath, J.W.; Vigh, N.; Muk, B.; Israel, C.W.; Kattih, B.; Pilecky, D.; Duray, G.Z.; Vamos, M. Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT‐Recipients. Preprints2023, 2023110477. https://doi.org/10.20944/preprints202311.0477.v1
Erath, J.W.; Vigh, N.; Muk, B.; Israel, C.W.; Kattih, B.; Pilecky, D.; Duray, G.Z.; Vamos, M. Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT‐Recipients. Preprints 2023, 2023110477. https://doi.org/10.20944/preprints202311.0477.v1
Erath, J.W.; Vigh, N.; Muk, B.; Israel, C.W.; Kattih, B.; Pilecky, D.; Duray, G.Z.; Vamos, M. Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT‐Recipients. Preprints2023, 2023110477. https://doi.org/10.20944/preprints202311.0477.v1
APA Style
Erath, J.W., Vigh, N., Muk, B., Israel, C.W., Kattih, B., Pilecky, D., Duray, G.Z., & Vamos, M. (2023). Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT‐Recipients. Preprints. https://doi.org/10.20944/preprints202311.0477.v1
Chicago/Turabian Style
Erath, J.W., Gabor Z Duray and Mate Vamos. 2023 "Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT‐Recipients" Preprints. https://doi.org/10.20944/preprints202311.0477.v1
Abstract
Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT).
Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed for a median of 28 months. Digitalis use was assessed at the time of CRT implantation. Multivariate Cox-regression model and propensity score matching was used to determine all-cause mortality as primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%), and ICD shocks were assessed as secondary endpoints.
Results: The study comprised 552 CRT recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR=1.14; 95% CI 0.88-1.5; p=0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR=1.04; 95% CI 0.75-1.45; p=0.82). Also, in comparison to 286 propensity score matched patients, mortality was not affected by digitalis intake (propensity adjusted HR=1.11; 95% CI 0.72-1.70; p=0.64). CRT response was predominant in digitalis non-users concerning both improvement of HF symptoms and LVEF (NYHA p<0.01; LVEF p<0.01) while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p=0.01).
Conclusions: Digitalis therapy had no effect on mortality but did negatively affect CRT response and susceptibility to ventricular arrhythmias requiring ICD shock treatment.
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
