The effects of Digoxin use on long-term prognosis in patients with heart failure with reduced ejection fraction.

OBJECTIVE: This study aimed to investigate the effect of digoxin on mortality and rehospitalization in heart failure with reduced ejection fraction (HFrEF) patients. Heart failure is a clinical syndrome that requires frequent rehospitalization and has a high mortality. This study aimed to investigate the effect of digoxin on mortality and rehospitalization in patients with heart failure with reduced ejection fraction. PATIENTS AND METHODS: The study included 326 patients with HFrEF that were hospitalized for decompensation between September 2014 and January 2016. The patients were divided into two groups: digoxin users and a control group. The study's endpoints were cardiovascular death and rehospitalization after 24-month long-term follow-ups. RESULTS: Rehospitalization was lower in patients taking digoxin (25% vs. 47%, p = 0.001). The mean age of patients taking digoxin (n: 78) was 63.7 ± 12.4 years, among which 64% were males. The mean age of the control group was 65.4 ± 11.8 years, among which 74% were males. However, there was no difference in mortality between the two groups (34% vs. 45%, p = 0.10). While Kaplan-Meier curves revealed no significant differences between mortality rates in the groups (log-rank p = 0.508), a statistical difference was found between the groups in rehospitalization rates (log-rank p =  0.013). A multiple linear regression analysis revealed that smoking (HR: 1.97, CI: 1.24-3.11, p = 0.004), systolic blood pressure (HR: 0.983, CI: 0.974-0.992, p < 0.001), atrial fibrillation (HR: 2.09, CI: 1.17-3.72, p = 0.012), C-reactive protein (CRP) (HR: 1.009, CI: 1.003-1.015, p = 0.004), beta-blockers (HR: 0.891, CI: 0.799-0.972, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (HR: 0.778, CI: 0.641-0.956, p < 0.001), mineralocorticoid receptor antagonists (HR: 0.41, CI:0.26-0.65, p < 0.001), and digoxin use (HR: 0.59, CI: 0.43-0.80, p = 0.001) are independent predictors of rehospitalization in patients with HFrEF. CONCLUSIONS: Our results show that digoxin use does not affect mortality in HFrEF patients. However, rehospitalization decreased in patients taking digoxin in HFrEF.

The relationship between QT dispersion and left and right ventricular diastolic dysfunction in patients with myocardial infarction.

OBJECTIVE: The purpose of this study was to investigate the relation between electrical dispersion and impairment of ventricular filling in patients with acute myocardial infarction (MI). METHODS: Thirty patients with recent myocardial infarction (17 patients with anterior and 13 patients with inferior MI) were included in the study. QT dispersion (QTd) was defined as maximum minus minimum QT interval durations. Flow propagation velocity measured by color m-mode echocardiography was used to determine diastolic function. RESULTS: There was a positive correlation between isovolumic relaxation time and QTd, as well as negative correlation existed between left ventricular flow propagation velocity (LVFPV) and QTd. The QTd was greater and LVFPV was lower in patients with anterior myocardial infarction as compared with those with inferior MI. CONCLUSION: There is an association between electrical dispersion and left ventricular filling abnormalities in patients with acute myocardial infarction.

[Enoxaparin for the Treatment of Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: the ENO-INT Study]. / Enoksaparin v lechenii nestabil'noi stenokardii i infarkta miokarda bez pod"emov segmenta ST: issledovanie ENO-INT.

UNLABELLED: AIM. To assess safety and efficacy of enoxaparin in patients with UA/NSTEMI in an open-label, multi-centre, non-comparative study and to compare the results with data from large-scale randomized trials ESSENCE and TIMI-11B. METHODS: Patients hospitalized with a diagnosis of recent UA/NSTEMI were treated with 1 mg/kg enoxaparin every 12 hours for 2-8 days. The composite endpoint of the study was death, myocardial infarction (MI) or recurrent angina at day 15 (or hospital discharge). Minor and major bleedings were recorded. RESULTS: A total of 1902 patients were enrolled in 109 centers across 24 countries, of which 1901 received at least one injection of enoxaparin and 1785 (93.8%) completed the study (follow-up). Throughout the study (day 180) 21.4% of patients underwent at least one revascularization, of which 4.4% were urgent. The incidence of the composite efficacy endpoint was 16.3% after 15 days and 27.9% on day 180, which was comparable with the enoxaparin arm of the ESSENCE/TIMI 11B studies, and lower than the incidence found in the UFH arm of those studies. At day 15 or hospital discharge the occurrence of major and minor haemorrhages was 1.1 and 6.6%, respectively, which was lower than in ESSENCE/TIMI 11B. More bleeding complications (major and minor) were noted in patients aged