Repurposing of the widely available and relatively cheap generic cardiac glycoside digoxin for non-cardiac indications could have a wide-ranging impact on the global burden of several diseases.Over the past several ye...Repurposing of the widely available and relatively cheap generic cardiac glycoside digoxin for non-cardiac indications could have a wide-ranging impact on the global burden of several diseases.Over the past several years,there have been significant advances in the study of digoxin pharmacology and its potential noncardiac clinical applications,including anti-inflammatory,antineoplastic,metabolic,and antimicrobial use.Digoxin holds promise in the treatment of gastrointestinal disease,including nonalcoholic steatohepatitis and alcoholassociated steatohepatitis as well as in obesity,cancer,and treatment of viral infections,among other conditions.In this review,we provide a summary of the clinical uses of digoxin to date and discuss recent research on its emerging applications.展开更多
We previously developed an HPLC method for determination of lanatoside C, digoxin and α-acetyldigoxin in digitalis glycosides isolated from Digitalis lanata leaves. Here, we present an improved HPLC-UV method to dete...We previously developed an HPLC method for determination of lanatoside C, digoxin and α-acetyldigoxin in digitalis glycosides isolated from Digitalis lanata leaves. Here, we present an improved HPLC-UV method to determine those compounds and deslanoside. We used the improved method to examine the effects of various pretreatments on the amounts of the four compounds isolated from the leaves, with the aim of maximizing the yield of digoxin. Leaves were extracted with 50% methanol, followed by clean-up on a Sep-Pak C18 cartridge prior to HPLC analysis. The amounts of lanatoside C, digoxin and α-acetyldigoxin per 100 mg of the leaves without pretreatment were 115.6, 7.45 and 23.8 μg, respectively (deslanoside was not detected). Pretreatment with acetic acid, which activated deglucosylation mediated by digilanidase present in the leaves, increased the amounts of digoxin and α-acetyldigoxin, while lanatoside C and deslanoside were not detected. Pretreatment with sodium methoxide, which hydrolyzed lanatoside C to deslanoside, increased the yields of deslanoside and digoxin, while lanatoside C and α-acetyldigoxin were not detected. The combination of both pretreatments afforded only digoxin in a yield of 115.1 μg/100 mg leaves. Use of the combined pretreatments appears to be effective for maximizing the yield of digoxin from the leaves.展开更多
AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive Pub Med search was performed using the key words "digoxin and conges...AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive Pub Med search was performed using the key words "digoxin and congestive heart failure", "digoxin and atrial fibrillation", "digoxin, atrial fibrillation and systolic congestive heart failure", and "digoxin and myocardial infarction". Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients(at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current recommendations.RESULTS: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm(n = 5), atrial fibrillation with and without systolic congestive heart failure(n = 9), and myocardial infarction(n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were more controversial. The extent to which discrepancies among studies are based on statistical methods is currently unclear, as these studies' findings are generated by retrospective analyses that employed different techniques to address confounding. CONCLUSION: Based on the potential risks and benefits, as well as the presence of alternative drugs, there is a limited role for digoxin in the management of patients with normal sinus rhythm and congestive heart failure. Based on the retrospective studies reviewed there is a growing volume of data showing increased mortality in those with only atrial fibrillation. The pro-per role of digoxin is, however, less certain in other subgroups of patients, such as those with both atrial fibrillation and systolic congestive heart failure or after a myocardial infarction. Further studies may provide helpful information for such subgroups of patients.展开更多
Fluorescence polarization immunoassay was used to study the chronopharmacokirietics of digoxin in 10 patients with congestive heart failure (CHF) who also served as self-controls. Our results showed that the serum dig...Fluorescence polarization immunoassay was used to study the chronopharmacokirietics of digoxin in 10 patients with congestive heart failure (CHF) who also served as self-controls. Our results showed that the serum digoxin concentration reached peak value 1h after taking digoxin at 7: 00 a. m.,but the serum digoxin concentration reached the peak value 2 h after taking digoxin at 4: 00 p. m.. The average serum digoxin concentration area under curve was greater and the best maintainable time of serum concentration within 24 h after taking digoxin at 4 p. m. longer than those at 7: 00 a. m.. The heart rates were obviously lower and the cardiac function was significantly improved in 4:00 p. m.group.展开更多
The Digoxin Investigation Group trial has multiple flaws in the trial design for the fi ndings to be universally applicable.Digoxin in low serum concentrations(0.5-0.9ng/mL)has been shown to decrease mortality in hear...The Digoxin Investigation Group trial has multiple flaws in the trial design for the fi ndings to be universally applicable.Digoxin in low serum concentrations(0.5-0.9ng/mL)has been shown to decrease mortality in heart failure patients.Multiple trials in different patient populations also show benefit of digoxin in heart failure patients,including women,elderly patients,renal disease patients,and patients with heart failure with preserved ejection fraction.Retrospective observational data linking digoxin use for treatment of atrial fi brillation to increased mortality is not seen in subgroups of randomized controlled trials or population registries.Digoxin remains a useful drug in the toolbox of physicians dealing with heart failure patients.展开更多
BACKGROUND The association between digoxin and mortality is an unclear issue.In older patients with atrial fibrillation(AF),where use of digoxin is frequent,the evidence of its safety is scarce.Our aim is to assess th...BACKGROUND The association between digoxin and mortality is an unclear issue.In older patients with atrial fibrillation(AF),where use of digoxin is frequent,the evidence of its safety is scarce.Our aim is to assess the safety of digoxin in nonagenarian patients with AF.METHODS We evaluated data from 795 nonagenarian patients with non-valvular AF from the Spanish Multicenter Registry.We analyzed the relationship between digoxin and all-cause mortality with the Cox proportional-hazards model.RESULTS Follow-up was 27.7±18.3 months.Mean age was 92.5±3.8 years,and 71%of nonagenarian patients were female.Digoxin was not associated with increased risk of mortality[adjusted hazard ratio(aHR)=1.16,95%CI:0.96−1.41,P=0.130].However,we found a significant increase in mortality in the subgroup with estimated glomerular filtration rate(eGFR)<30 mL/min per 1.73 m^(2)(aHR=2.01,95%CI:1.13−3.57,P=0.018),but not in the other subgroups of eGFR(30−59 mL/min per 1.73 m^(2) and≥60 mL/min per 1.73 m^(2)).When exploring the risk of mortality according to sex,male subgroup was associated with an in-crease in mortality(aHR=1.48,95%CI:1.02−2.14,P=0.041).This was not observed in females subgroup(aHR=1.03,95%CI:0.81−1.29,P=0.829).Based on the presence or absence of heart failure,we did not find significant differences(aHR=1.20,95%CI:0.87−1.65,P=0.268 vs.aHR=1.15,95%CI:0.90−1.47,P=0.273,respectively).CONCLUSIONS In our large registry of nonagenarian patients with AF,we did not find an association between digoxin and mortality in the total sample.However,in the subgroup analyses,we found an increase in mortality with the use of digoxin in men and in patients with an eGFR<30 mL/min per 1.73 m^(2).展开更多
Objective To compare the effects or ouabain and digoxin on both the systolic blood pressure and sodium pump a-subunit isoforms gene expression in the aortic smooth muscle of rats. Methods Normal Sprague- Dawley rats w...Objective To compare the effects or ouabain and digoxin on both the systolic blood pressure and sodium pump a-subunit isoforms gene expression in the aortic smooth muscle of rats. Methods Normal Sprague- Dawley rats were injected with ouabain (20μg·kg-1·d-l,i. p), digoxin (32 μg·kg-1·d-1, i. p)and normal saline once a day, respectively, and indirect systolic blood pressure was recorded once a week. Six weeks later,all the rats were killed and sodium pump α1-,α2-,and α3-subunit mRNA levels were detected in the aortic smooth muscle with reverse transcription polymerase chain reaction（RT-PCR） method. Results The systolic blood pressure of rats infused with ouabain increased significantly at the end of week 6 [l32. 6±9.0 mmHg （1 mmHg = 0. 133 kPa） vs 115. 7 ± 8. 2 mmHg, P <0.01],while no difference of blood pressure was found between digoxin group and NS group （P>0.05）. The expression or sodium pump α-subunit isoforms in aortic smooth muscle was regulated by either ouabain or digox- in:both ouabain and digoxin increased α1- and α3-subunit expression, α2-subunit decreased in digoxin group but un- changed in ouabain group. Conclusion These results suggest that both ouabain and digoxin could regulate sodium pump α-subunit isoform expression, which might be related to the physiological roles or endogenous ouabain and might be responsible for the difference between the pharmacological and toxicological effects or ouabain and digoxin, including their effects on blood pressure.展开更多
BACKGROUND Cardiac and hepatic functionality are intertwined in a multifaceted relationship.Pathologic processes involving one may affect the other through a variety of mechanisms,including hemodynamic and membrane tr...BACKGROUND Cardiac and hepatic functionality are intertwined in a multifaceted relationship.Pathologic processes involving one may affect the other through a variety of mechanisms,including hemodynamic and membrane transport effects.AIM To better understand the effect of extrahepatic cholestasis on regulations of membrane transporters involving digoxin and its implication for digoxin clearance.METHODS Twelve adult rats were included in this study;baseline hepatic and renal laboratory values and digoxin pharmacokinetic(PK)studies were established before evenly dividing them into two groups to undergo bile duct ligation(BDL)or a sham procedure.After 7 d repeat digoxin PK studies were completed and tissue samples were taken to determine the expressions of cell membrane transport proteins by quantitative western blot and real-time polymerase chain reaction.Data were analyzed using SigmaStat 3.5.Means between pre-surgery and post-surgery in the same experimental group were compared by paired t-test,while independent t-test was employed to compare the means between sham and BDL groups.RESULTS Digoxin clearance was decreased and liver function,but not renal function,was impaired in BDL rats.BDL resulted in significant up-regulation of multidrug resistance 1 expression in the liver and kidney and its down-regulation in the small intestine.Organic anion transporting polypeptides(OATP)1A4 was up-regulated in the liver but down-regulated in intestine after BDL.OATP4C1 expression was markedly increased in the kidney following BDL.CONCLUSION The results suggest that cell membrane transporters of digoxin are regulated during extrahepatic cholestasis.These regulations are favorable for increasing digoxin excretion in the kidney and decreasing its absorption from the intestine to compensate for reduced digoxin clearance due to cholestasis.展开更多
Objective:To explore the effect of digoxin and Tongxin capsule combined therapy on oxidative stress, cytokines and vascular endothelial function in patients with chronic heart failure, and provide help for clinical tr...Objective:To explore the effect of digoxin and Tongxin capsule combined therapy on oxidative stress, cytokines and vascular endothelial function in patients with chronic heart failure, and provide help for clinical treatment of patients with chronic heart failure.Methods:95 cases of chronic heart failure in our hospital were randomly divided into observation group (47 cases) and control group (48 cases). Control group patients were given basic treatment, and observation group received combination therapy of digoxin and Tongxinluo capsule, to detect and to investigate the changes of oxidative stress, cytokines and vascular endothelial function in two groups of patients before and after treatment.Results:There was no significant difference in oxidative stress, cytokines and vascular endothelial function between the two groups of chronic heart failure patients before treatment (P>0.05). Compared with before treatment, the malondialdehyde (MDA) and cytokines [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6) and brain natriuretic peptide (BNP)] in two groups of patients with chronic heart failure after treatment decreased significantly (P<0.05), while indexes related to endothelial function [hyperemic brachial artery diameter after reactive hyperemia, brachial artery diameter change rate, brachial artery endothelial dependent diastolic function (FMD), and brachial artery endothelium dependent diastolic function (NMD)] and related indexes of oxidative stress [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT)] were significantly increased (P<0.05). The related indexes and oxidative stress indexes (GSH-Px, CAT and SOD) of observation group after the combined treatment in patients with endothelial function were significantly higher than the control group after treatment (P<0.05). After treatment, cytokines and MDA levels were significantly lower than the control group (P<0.05).Conclusions:Tongxinluo capsule combined with digoxin treatment significantly improved the oxidative stress, cytokines and vascular endothelial function levels in patients with chronic heart failure, and has important clinical significance for the treatment of patients with chronic heart failure.展开更多
基金Supported by NIH UO1(to Mehal WZ),No.5U01AA026962-02.
文摘Repurposing of the widely available and relatively cheap generic cardiac glycoside digoxin for non-cardiac indications could have a wide-ranging impact on the global burden of several diseases.Over the past several years,there have been significant advances in the study of digoxin pharmacology and its potential noncardiac clinical applications,including anti-inflammatory,antineoplastic,metabolic,and antimicrobial use.Digoxin holds promise in the treatment of gastrointestinal disease,including nonalcoholic steatohepatitis and alcoholassociated steatohepatitis as well as in obesity,cancer,and treatment of viral infections,among other conditions.In this review,we provide a summary of the clinical uses of digoxin to date and discuss recent research on its emerging applications.
文摘We previously developed an HPLC method for determination of lanatoside C, digoxin and α-acetyldigoxin in digitalis glycosides isolated from Digitalis lanata leaves. Here, we present an improved HPLC-UV method to determine those compounds and deslanoside. We used the improved method to examine the effects of various pretreatments on the amounts of the four compounds isolated from the leaves, with the aim of maximizing the yield of digoxin. Leaves were extracted with 50% methanol, followed by clean-up on a Sep-Pak C18 cartridge prior to HPLC analysis. The amounts of lanatoside C, digoxin and α-acetyldigoxin per 100 mg of the leaves without pretreatment were 115.6, 7.45 and 23.8 μg, respectively (deslanoside was not detected). Pretreatment with acetic acid, which activated deglucosylation mediated by digilanidase present in the leaves, increased the amounts of digoxin and α-acetyldigoxin, while lanatoside C and deslanoside were not detected. Pretreatment with sodium methoxide, which hydrolyzed lanatoside C to deslanoside, increased the yields of deslanoside and digoxin, while lanatoside C and α-acetyldigoxin were not detected. The combination of both pretreatments afforded only digoxin in a yield of 115.1 μg/100 mg leaves. Use of the combined pretreatments appears to be effective for maximizing the yield of digoxin from the leaves.
文摘AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive Pub Med search was performed using the key words "digoxin and congestive heart failure", "digoxin and atrial fibrillation", "digoxin, atrial fibrillation and systolic congestive heart failure", and "digoxin and myocardial infarction". Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients(at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current recommendations.RESULTS: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm(n = 5), atrial fibrillation with and without systolic congestive heart failure(n = 9), and myocardial infarction(n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were more controversial. The extent to which discrepancies among studies are based on statistical methods is currently unclear, as these studies' findings are generated by retrospective analyses that employed different techniques to address confounding. CONCLUSION: Based on the potential risks and benefits, as well as the presence of alternative drugs, there is a limited role for digoxin in the management of patients with normal sinus rhythm and congestive heart failure. Based on the retrospective studies reviewed there is a growing volume of data showing increased mortality in those with only atrial fibrillation. The pro-per role of digoxin is, however, less certain in other subgroups of patients, such as those with both atrial fibrillation and systolic congestive heart failure or after a myocardial infarction. Further studies may provide helpful information for such subgroups of patients.
文摘Fluorescence polarization immunoassay was used to study the chronopharmacokirietics of digoxin in 10 patients with congestive heart failure (CHF) who also served as self-controls. Our results showed that the serum digoxin concentration reached peak value 1h after taking digoxin at 7: 00 a. m.,but the serum digoxin concentration reached the peak value 2 h after taking digoxin at 4: 00 p. m.. The average serum digoxin concentration area under curve was greater and the best maintainable time of serum concentration within 24 h after taking digoxin at 4 p. m. longer than those at 7: 00 a. m.. The heart rates were obviously lower and the cardiac function was significantly improved in 4:00 p. m.group.
文摘The Digoxin Investigation Group trial has multiple flaws in the trial design for the fi ndings to be universally applicable.Digoxin in low serum concentrations(0.5-0.9ng/mL)has been shown to decrease mortality in heart failure patients.Multiple trials in different patient populations also show benefit of digoxin in heart failure patients,including women,elderly patients,renal disease patients,and patients with heart failure with preserved ejection fraction.Retrospective observational data linking digoxin use for treatment of atrial fi brillation to increased mortality is not seen in subgroups of randomized controlled trials or population registries.Digoxin remains a useful drug in the toolbox of physicians dealing with heart failure patients.
文摘BACKGROUND The association between digoxin and mortality is an unclear issue.In older patients with atrial fibrillation(AF),where use of digoxin is frequent,the evidence of its safety is scarce.Our aim is to assess the safety of digoxin in nonagenarian patients with AF.METHODS We evaluated data from 795 nonagenarian patients with non-valvular AF from the Spanish Multicenter Registry.We analyzed the relationship between digoxin and all-cause mortality with the Cox proportional-hazards model.RESULTS Follow-up was 27.7±18.3 months.Mean age was 92.5±3.8 years,and 71%of nonagenarian patients were female.Digoxin was not associated with increased risk of mortality[adjusted hazard ratio(aHR)=1.16,95%CI:0.96−1.41,P=0.130].However,we found a significant increase in mortality in the subgroup with estimated glomerular filtration rate(eGFR)<30 mL/min per 1.73 m^(2)(aHR=2.01,95%CI:1.13−3.57,P=0.018),but not in the other subgroups of eGFR(30−59 mL/min per 1.73 m^(2) and≥60 mL/min per 1.73 m^(2)).When exploring the risk of mortality according to sex,male subgroup was associated with an in-crease in mortality(aHR=1.48,95%CI:1.02−2.14,P=0.041).This was not observed in females subgroup(aHR=1.03,95%CI:0.81−1.29,P=0.829).Based on the presence or absence of heart failure,we did not find significant differences(aHR=1.20,95%CI:0.87−1.65,P=0.268 vs.aHR=1.15,95%CI:0.90−1.47,P=0.273,respectively).CONCLUSIONS In our large registry of nonagenarian patients with AF,we did not find an association between digoxin and mortality in the total sample.However,in the subgroup analyses,we found an increase in mortality with the use of digoxin in men and in patients with an eGFR<30 mL/min per 1.73 m^(2).
基金This project supported by the National Natural Science Foundation of China(No. 39670325).
文摘Objective To compare the effects or ouabain and digoxin on both the systolic blood pressure and sodium pump a-subunit isoforms gene expression in the aortic smooth muscle of rats. Methods Normal Sprague- Dawley rats were injected with ouabain (20μg·kg-1·d-l,i. p), digoxin (32 μg·kg-1·d-1, i. p)and normal saline once a day, respectively, and indirect systolic blood pressure was recorded once a week. Six weeks later,all the rats were killed and sodium pump α1-,α2-,and α3-subunit mRNA levels were detected in the aortic smooth muscle with reverse transcription polymerase chain reaction（RT-PCR） method. Results The systolic blood pressure of rats infused with ouabain increased significantly at the end of week 6 [l32. 6±9.0 mmHg （1 mmHg = 0. 133 kPa） vs 115. 7 ± 8. 2 mmHg, P <0.01],while no difference of blood pressure was found between digoxin group and NS group （P>0.05）. The expression or sodium pump α-subunit isoforms in aortic smooth muscle was regulated by either ouabain or digox- in:both ouabain and digoxin increased α1- and α3-subunit expression, α2-subunit decreased in digoxin group but un- changed in ouabain group. Conclusion These results suggest that both ouabain and digoxin could regulate sodium pump α-subunit isoform expression, which might be related to the physiological roles or endogenous ouabain and might be responsible for the difference between the pharmacological and toxicological effects or ouabain and digoxin, including their effects on blood pressure.
文摘BACKGROUND Cardiac and hepatic functionality are intertwined in a multifaceted relationship.Pathologic processes involving one may affect the other through a variety of mechanisms,including hemodynamic and membrane transport effects.AIM To better understand the effect of extrahepatic cholestasis on regulations of membrane transporters involving digoxin and its implication for digoxin clearance.METHODS Twelve adult rats were included in this study;baseline hepatic and renal laboratory values and digoxin pharmacokinetic(PK)studies were established before evenly dividing them into two groups to undergo bile duct ligation(BDL)or a sham procedure.After 7 d repeat digoxin PK studies were completed and tissue samples were taken to determine the expressions of cell membrane transport proteins by quantitative western blot and real-time polymerase chain reaction.Data were analyzed using SigmaStat 3.5.Means between pre-surgery and post-surgery in the same experimental group were compared by paired t-test,while independent t-test was employed to compare the means between sham and BDL groups.RESULTS Digoxin clearance was decreased and liver function,but not renal function,was impaired in BDL rats.BDL resulted in significant up-regulation of multidrug resistance 1 expression in the liver and kidney and its down-regulation in the small intestine.Organic anion transporting polypeptides(OATP)1A4 was up-regulated in the liver but down-regulated in intestine after BDL.OATP4C1 expression was markedly increased in the kidney following BDL.CONCLUSION The results suggest that cell membrane transporters of digoxin are regulated during extrahepatic cholestasis.These regulations are favorable for increasing digoxin excretion in the kidney and decreasing its absorption from the intestine to compensate for reduced digoxin clearance due to cholestasis.
文摘Objective:To explore the effect of digoxin and Tongxin capsule combined therapy on oxidative stress, cytokines and vascular endothelial function in patients with chronic heart failure, and provide help for clinical treatment of patients with chronic heart failure.Methods:95 cases of chronic heart failure in our hospital were randomly divided into observation group (47 cases) and control group (48 cases). Control group patients were given basic treatment, and observation group received combination therapy of digoxin and Tongxinluo capsule, to detect and to investigate the changes of oxidative stress, cytokines and vascular endothelial function in two groups of patients before and after treatment.Results:There was no significant difference in oxidative stress, cytokines and vascular endothelial function between the two groups of chronic heart failure patients before treatment (P>0.05). Compared with before treatment, the malondialdehyde (MDA) and cytokines [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6) and brain natriuretic peptide (BNP)] in two groups of patients with chronic heart failure after treatment decreased significantly (P<0.05), while indexes related to endothelial function [hyperemic brachial artery diameter after reactive hyperemia, brachial artery diameter change rate, brachial artery endothelial dependent diastolic function (FMD), and brachial artery endothelium dependent diastolic function (NMD)] and related indexes of oxidative stress [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT)] were significantly increased (P<0.05). The related indexes and oxidative stress indexes (GSH-Px, CAT and SOD) of observation group after the combined treatment in patients with endothelial function were significantly higher than the control group after treatment (P<0.05). After treatment, cytokines and MDA levels were significantly lower than the control group (P<0.05).Conclusions:Tongxinluo capsule combined with digoxin treatment significantly improved the oxidative stress, cytokines and vascular endothelial function levels in patients with chronic heart failure, and has important clinical significance for the treatment of patients with chronic heart failure.
