Comparación de digoxina y enalapril en insuficiencia cardíaca secundaria a insuficiencia mitral / Comparison of the effects of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency

ABSTRACT

Background: There is not much evidence about the usefulness of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency. Aim: to compare digoxin and enalapril in the treatmen of heart failure due to mitral insufficiency. Patients and methods: Patients with mitral insufficiency, in sinus rhythm, with a heart failure grade II or III and with echocardiographic left ventricular dilatation were eligible for the study. They received sequentially, during 12 weeks each, digoxin 0.25 mg/day or enalapril in doses up to 20 mg/day, with a washout in-between period of 2 weeks. The order of the sequence was determined randomly. At the start and end of treatment, functional class according to NYHA and maximal exercise tolerance in the treadmil were assessed and a color Doppler echocardiogram was done to measure ventricular dimensions, function and degree of mitral insufficiency. Results: Nine patients on enalapril and 12 on digoxin improved their functional capacity. Digoxin improved exercise time in 76ñ168 sec (p= 0.022), whereas this change was not significant with enalapril (38ñ158 sec; p= 0.2). With enalapril treatmen, ventricular diastolic dimensiondecreased from 59.3ñ8.1 to 58ñ9.3 mm and the area of mitral insufficiency decreased from 8.1ñ3.5 to 6.6ñ3.1 cm2. Digoxin did not induce any significant echocardiographic change. Conclusions: In these patients, digoxin and enalapril improved functional class. Digoxin improved exercise time and enalapril reduced ventricular dimensions and mitral insufficiency