Authors: Muzzarelli, S.¹; Stricker, H.²; Pfister, O.³; Foglia, P.⁴; Moschovitis, G.⁵; Mombelli, G.²; Brunner-La Rocca, H.⁶

Source: QJM: An International Journal of Medicine, Volume 104, Number 4, 23 April 2011 , pp. 309-317(9)

Publisher: Oxford University Press

Abstract:

Backgroud: After the publication of DIG trial, the therapeutic target of serum digoxin concentration (SDC) for the treatment of heart failure (HF) has been lowered (0.401.00ng/ml). However, the majority of equations to calculate digoxin dosages were developed for higher SDCs. Recently, a new equation was validated in Asian population for low SDCs by Konishi et al., but results in Caucasians are unknown.

Aim: This study was aimed to test the Konishi equation in Caucasians specifically targeting low SDCs. Furthermore, the Konishi equation was compared with other frequently used equations.

Design: This was a prospective, multicenter study.

Methods: Clinically indicated digoxin was given in 40 HF patients. The dosage was calculated with the Konishi equation. The SDC was measured at 1 and 6 months after starting digoxin. Adherence to digoxin was monitored with a specific questionnaire.

Results: After exclusion of patients admitting poor adherence, we found a reasonable correlation between predicted and measured SDC (r0.48; P<0.01) by the Konishi equation. Excluding patients with poor adherence and relevant worsening of renal function, the measured SDC (n54 measurements) was within the pre-defined therapeutic range in 95 of the cases. The mean, maximal and minimal measured SDC were 0.690.19, 1.00 and 0.32ng/ml, respectively. The correlation was weaker for the Jelliffe, the Koup and Jusko, and the Bauman equations.

Conclusions: This study supports the clinical validity of the Konishi equation for calculating individual digoxin dosage in Caucasians, targeting SDCs according to current HF guidelines.

Document Type: Research article

DOI: http://dx.doi.org/10.1093/qjmed/hcq196

Affiliations: 1: Cardiology Department, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland, Radiology Department, Cardiac and Pulmonary Imaging, University of California, San Francisco, California, USA, , 2: Department of Internal Medicine, Regional Hospital of Locarno, Via all'Ospedale 1, CH-6600 Locarno, , 3: Cardiology Department, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland, , 4: Department of Internal Medicine, Regional Hospital of Locarno, Via all'Ospedale 1, CH-6600 Locarno, Cardiology Department, University Hospital Bern, Freiburgstrasse, CH-3010 Bern, , 5: Cardiology Department, Regional Hospital of Lugano, Via Tesserete, CH-6900 Lugano, Switzerland and , 6: Cardiology Department, University Hospital Maastricht, P. Debyelaan 25, NL-6202 AZ Maastricht, The Netherlands,

Publication date: 2011-04-23

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• QJM is a long-established, leading general medical journal. It focuses on internal medicine and publishes peer-reviewed articles which promote medical science and practice. Published monthly, QJM includes original papers, editorials, reviews, commentary papers to air controversial issues, and a correspondence column.

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