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Journal : Paediatrica Indonesiana

Plasma digoxin levels and ejection fraction in pediatric heart failure Nafrialdi Nafrialdi; Sake Juli Martina; Mulyadi Djer; Melva Louisa
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (107.029 KB) | DOI: 10.14238/pi55.6.2015.322-7

Abstract

Background Digoxin has long been prescribed in children with heart failure, but its efficacy has not been evaluated. A previous study at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital revealed that plasma digoxin levels, following a maintenance dose of 15 μg/kg/d, were sub-therapeutic. Regarding its narrow margin of safety, the trend is to use digoxin in even lower dose. Thus, the drug’s impact on cardiac performance need to be evaluated. Objective To evaluate whether a lower maintenance dose of digoxin (10 μg/kg/d) is sufficient to achieve a therapeutic level and to assess for possible correlations between plasma digoxin level and left ventricular ejection fraction (LVEF) as well as fractional shortening (LVFS). Methods A cross-sectional study was conducted on 20 pediatric heart failure patients at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, from January to May 2012. Plasma digoxin levels were measured by ELISA method after one month or more of treatment; LVEF and LVFS were measured by echocardiography. Correlations between plasma digoxin level and LVEF or LVFS were analyzed by Spearman’s correlation test. The LVEF before and after digoxin treatment were compared by paired T-test. Results Thirteen out of 20 patients had plasma digoxin levels within therapeutic range (0.5-1.5 ng/mL; 95%CI 0.599 to 0.898) and 7 had sub-therapeutic levels (<0.5 ng/ mL; 95%CI 0.252 to 0.417). No significant correlations were observed between plasma digoxin level and LVEF (r=-0.085; P=0.722) or LVFS (r=-0.105; P=0.659). There was a significant increase in LVEF before [42.18 (SD 14.15)%] and after digoxin treatment [57.52 (SD 11.09)%], (P < 0.0001). Conclusion Most patients in this study have plasma digoxin levels within therapeutic range. There are no significant correlations between plasma digoxin level at the time point of measurement and LVEF or LVFS. However, an increase of LVEF is observed in every individual patients following digoxin treatment.
Co-Authors -, Paramita Achmad, Fariz Adam Iskandarmudasyah Adhayati, Baety Adisti Dwijayanti Agnes Frethernety Agus D. Susanto Ahmad Aulia Ali Sodikin Amanah Amanah Anang Endaryanto Andita Fitri Mutiara Rizki, Andita Fitri Mutiara Angelica Riadi Alim Saputro Angelina Riadi Alim Saputro Anom Bowo Laksono Anton Bahtiar Anton Bahtiar Ari Estuningtyas, Ari Aria Kekalih Arini Setiawati Arini Setiawati Arleni Arleni Aurelia Demtari Tuah Ayu Suraduhita Azmi, Wihda Aisarul Barasila, Atikah Chalida Budi Setiabudiawan Budi Wiweko Clara Riski Amanda Deni Rahmat Dewi, Yulia Ratna Didi Haryadi Didi Haryadi Dina Muktiarti, Dina Elisna Syahruddin Elly Yanah Arwanih Elvira Yunita Erlina Santoso Erni H. Purwaningsih Eziefule, Oluebube Magnificient Fajri, Purnama Fasha, Iqbal Franciscus D. Suyatna Frans D. Suyatna Gayatri, Anggi Gigih Andy Putra, Achmad Ginting, Tribowo T. Halim, Kelvin Handayani, Nur Hayati Dwi HANS-JOACHIM FREISLEBEN I MADE ARTIKA Indah D Dewijanti Indah D Dewijanti, Indah D Irandi Putra Pratomo Jeanne Adiwinata Pawitan Johannes Hudyono Kania, Theresia Kato, Mitsuyasu Ketut Dewi Kumara Wati Khariri Khariri Layal, Kamalia Made Susiyanti Madoka Takeuchi Manggiasih Dwiayu Larasati Masahiro Takeuchi Mega Putri Utami Mila Maidarti Mizuno, Seiya Muhaimin Muhaimin Mulyadi Djer Nabillah, Deya Adiby Nafrialdi Nafrialdi Nasrun, Martina WS. Ni Made Dwi Sandhiutami Nihayah, Silviatun Nining Handayani Novi S. Hardiany Novita, Rachma Nur Hayati Dwi Handayani Pandelaki, Jacub Paramita - Paramita - Paramita, Paramita Perdhana, Ika S. Puspita E. Wuyung Puspita Eka Wuyung Puspita Eka Wuyung Puteri, Meidi U. Putrihamidah, Diyanthie Aulia Rachma Novita Rachma Novita Rachman, Andika Radiana Dhewayani Antarianto Raymond R. Tjandrawinata Rebecca Noerjani Angka Resda Akhra Syahrani Rianto Setiabudy Rianyta Rianyta Rika Sari Dewi Safitri, Yolanda Sake Juli Martina SEKAR ARUMSARI, SEKAR Septelia I. Wanandi Septelia Inawati Wanandi SEPTELIA INAWATI WANANDI Setiabudy, Rahajuningsih D Shafilla Yunilma Andriany Sianipar, Erlia Anggrainy Sianipar, Erlia Anggrainy Siregar, Josephine Elizabeth Siste, Kristiana Sri W.A. Jusman Sumadiono Sumadiono Suratih, Ni Made Desy Susanto, Eka Syahrani, Resda A. Syarifah Dewi Tarigan, Immanuel N. Tri Yuliani Tri Yuliani, Tri Trishna, Alya R. Ungke Antonjaya Utami, Diah S. Vivian Soetikno Vivian Soetikno Vivian Soetikno Wahyunia Likhayati Septiana Wardhani, Bantari W.K. Watanabe, Yukihide Watanabe, Yukihide Wawaimuli Arozal Widyawati, Syska Yolanda Safitri Yolanda Safitri Zakiudin Munasir