scholarly journals The effect of autoantibody against M2-muscarinic acetylcholine receptor in peripartum cardiomyopathy patients on digoxin additional to standard treatment

2020 ◽  
Author(s):  
Guiling Ma ◽  
Long Chen ◽  
Yin Yue ◽  
Xiyan Liu ◽  
Yidan Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Standard Treatment ◽  
Muscarinic Acetylcholine Receptor ◽  
Poor Response ◽  
Digoxin Concentration ◽  
Serum Digoxin Concentration ◽  
Peripartum Cardiomyopathy ◽  
Negative Group ◽  
Positive Group

Abstract Background: To evaluate the effects of autoantibodies against the M2-muscarinic receptor (anti-M2-R) on digoxin additional to standard treatment in peripartum cardiomyopathy (PPCM) patients.Methods: 86 PPCM patients were separated into anti-M2-R negative or positive group according to the anti-M2-R reactivity. All the patients received digoxin additional to standard treatment regimen. Echocardiography was performed at baseline and after 5 years treatment. Serum digoxin concentration (SDC) were performed every 3 to 6 months. All-cause mortality, cardiovascular mortality and re-hospitalization for heart failure were compared after 5 years of follow-up.Results: There were 82 patients completed the final data analysis, including 38 in the anti-M2-R (+) group and 44 in the anti-M2-R (-) group. The heart rate of the positive group was higher than that of the negative group at baseline (102.3 ± 6.3 vs. 95.9 ± 6.8, p < 0.001). The initial SDC of patients in the positive group was higher than that of patients in the negative group with the same dose of digoxin (1.21 ± 0.41 vs. 0.73 ± 0.16 ng/mL, p < 0.001). Patients in the anti-M2-R (-) group had better tolerance to metoprolol and digoxin (p < 0.05). All the PPCM patients showed prominent improvement in cardiac function, especially in the anti-M2-R (-) group. Re-hospitalization for heart failure was decreased in the negative group, but not of all-cause or cardiovascular mortality. Conclusions: Patients negative for anti-M2-R showed better tolerance to metoprolol and digoxin. Anti-M2-R maybe a predictor for vagus nerve overactivation and is associated with poor response to digoxin treatment in PPCM patients.

scholarly journals Effects of autoantibody against M2-muscarinic acetylcholine receptor in peripartum cardiomyopathy patients on digoxin additional to standard treatment

2021 ◽  
Author(s):  
Guiling Ma ◽  
Long Chen ◽  
Yin Yue ◽  
Xiyan Liu ◽  
Yidan Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Standard Treatment ◽  
Heart Function ◽  
Muscarinic Acetylcholine Receptor ◽  
Poor Response ◽  
Digoxin Concentration ◽  
Peripartum Cardiomyopathy ◽  
Negative Group ◽  
Positive Group

Abstract Objectives To evaluate the effects of autoantibodies against the M2-muscarinic receptor (anti-M2-R) on digoxin additional to standard treatment in peripartum cardiomyopathy (PPCM) patients. Methods 107 PPCM patients, receiving digoxin and standard treatment regimen for HF, were enrolled between January 1998 and June 2020, who were separated into anti-M2-R negative (n = 59) or positive (n = 48) group according to the anti-M2-R reactivity. Echocardiography and serum digoxin concentration (SDC) were performed regularly. All-cause mortality, cardiovascular mortality and re-hospitalization for heart failure were compared. Results 103 patients completed the final data analysis, including 46 in the anti-M2-R (+) group and 57 in the anti-M2-R (-) group. Heart rate of the positive group was lower than that of the negative group at baseline (102.7 ± 6.1 vs. 96.0 ± 6.4, p < 0.001). The initial SDC of patients in the positive group was higher than that of patients in the negative group with the same dosage of digoxin (1.25 ± 0.45 vs. 0.78 ± 0.24 ng/mL, p < 0.001). Anti-M2-R (-) patients had better tolerance to metoprolol (38.4 ± 4.6 mg b.i.d. vs. 27.4 ± 5.0 mg b.i.d., p < 0.0001) and digoxin (0.12 ± 0.02 mg/day vs. 0.08 ± 0.04 mg/day, p < 0.0001). The improvement of heart function was obvious in the first year, especially in the first half. Furthermore, anti-M2-R (-) patients showed better improvement than that in anti-M2-R (+) patients. Re-hospitalization for heart failure was decreased in the negative group, but not of all-cause or cardiovascular mortality. Conclusions Anti-M2-R maybe a predictor for vagus nerve overactivation and is associated with poor response to digoxin in PPCM patients.

scholarly journals Impact of autoantibodies against the M2-muscarinic acetylcholine receptor on clinical outcomes in peripartum cardiomyopathy patients with standard treatment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guiling Ma ◽  
Long Chen ◽  
Yin Yue ◽  
Xiyan Liu ◽  
Yidan Wang ◽  
...  
Keyword(s):  
Cardiac Function ◽  
Clinical Outcomes ◽  
Cardiovascular Mortality ◽  
Standard Treatment ◽  
Muscarinic Acetylcholine Receptor ◽  
Digoxin Concentration ◽  
Peripartum Cardiomyopathy ◽  
All Cause Mortality ◽  
The Impact ◽  
Rehospitalisation Rate

Abstract Objectives To evaluate the impact of autoantibodies against the M2-muscarinic receptor (anti-M2-R) on the clinical outcomes of patients receiving the standard treatment for peripartum cardiomyopathy (PPCM). Methods A total of 107 PPCM patients who received standard heart failure (HF) treatment between January 1998 and June 2020 were enrolled in this study. According to anti-M2-R reactivity, they were classified into negative (n = 59) and positive (n = 48) groups, denoted as the anti-M2-R (−) and anti-M2-R (+) groups. Echocardiography, 6-min walk distance, serum digoxin concentration (SDC), and routine laboratory tests were performed regularly for 2 years. The all-cause mortality, cardiovascular mortality, and rehospitalisation rate for HF were compared between the two groups. Results A total of 103 patients were included in the final data analysis, with 46 in the anti-M2-R (+) group and 57 in the anti-M2-R (−) group. Heart rate was lower in the anti-M2-R (+) group than in the anti-M2-R (−) group at the baseline (102.7 ± 6.1 bpm vs. 96.0 ± 6.4 bpm, p < 0.001). The initial SDC was higher in the anti-M2-R (+) group than in the anti-M2-R (−) group with the same dosage of digoxin (1.25 ± 0.45 vs. 0.78 ± 0.24 ng/mL, p < 0.001). The dosages of metoprolol and digoxin were higher in the anti-M2-R (−) patients than in the anti-M2-R (+) patients (38.8 ± 4.6 mg b.i.d. vs. 27.8 ± 5.3 mg b.i.d., p < 0.0001, respectively, for metoprolol; 0.12 ± 0.02 mg/day vs. 0.08 ± 0.04 mg/day, p < 0.0001, respectively, for digoxin). Furthermore, there was a greater improvement in cardiac function in the anti-M2-R (−) patients than in the anti-M2-R (+) patients. Multivariate analysis identified negativity for anti-M2-R as the independent predictor for the improvement of cardiac function. Rehospitalisation for HF was lower in the anti-M2-R (−) group, but all-cause mortality and cardiovascular mortality were the same. Conclusions There were no differences in all-cause mortality or cardiovascular mortality between the two groups. Rehospitalisation rate for HF decreased in the anti-M2-R (−) group. This difference may be related to the regulation of the autonomic nervous system by anti-M2-R.

The Effect of Autoantibody against M2-Muscarinic Acetylcholine Receptor in Heart Failure Patients on Digoxin Treatment

Cardiology ◽  
2018 ◽  
Vol 141 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Dongyan Hou ◽  
Zhenping  Fan ◽  
Lin  Xu ◽  
Hua  Wang ◽  
Zhiyong  Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acetylcholine Receptor ◽  
Standard Treatment ◽  
Muscarinic Acetylcholine Receptor ◽  
Poor Response ◽  
Digoxin Concentration ◽  
Left Ventricular ◽  
Treatment Regime ◽  
Target Antigen ◽  
Muscarinic Acetylcholine

Background: Autoantibody against M2-muscarinic acetylcholine receptor (anti-M2AChR) has a biological effect similar to a vagus agonist. Digoxin has a function of vagus nervous system stimulation. We hypothesized that anti-M2AChR is highly correlated with digoxin in patients with chronic heart failure (CHF). Methods: Synthetic M2AChR peptides served as the target antigen in an ELISA were used to screen the sera of 80 CHF patients, who were separated into a negative (–) or positive (+) anti-M2AChR group according to their anti-M2AChR reactivity. Echocardiography and serum digoxin concentration (SDC) were performed at baseline and after 1 year of digoxin in combination with the standard treatment regime. The end-point events were compared over 1 year of follow-up. Results: Seventy-two CHF patients completed the final data analysis, including 32 (+)anti-M2AChR and 40 (–)anti-M2AChR patients. The resting heart rate of the positive group was higher than that of the negative group at baseline (p < 0.05; 89.0 ± 1.6 vs. 83.8 ± 1.1 bpm). Both groups showed improvement in the left ventricular end-diastolic and end-systolic dimensions and ejection fraction with digoxin in combination with the standard treatment regime for 1 year (all p < 0.01). However, the 32 patients with (–)anti-M2AChR had greater improvements than the 40 patients with (+)anti-M2AChR, and this was accompanied by a marked decrease of rehospitalization (all p < 0.01) but not of cardiovascular mortality after 1 year. The SDC of patients with (–)anti-M2AChR was significantly lower than that of patients with (+)anti-M2AChR (p < 0.05; 0.63 ± 0.05 vs.1.16 ± 0.06 ng/mL) and had a positive correlation with anti-M2AChR (r = 0.81, p < 0.001). Conclusion: These results suggested that anti-M2AChR could be a useful biomarker of vagus nerve overactivation and is associated with a poor response to digoxin treatment in CHF patients.

2. Report of a Suicidal Digoxin Intoxication: A Case Report

2002 ◽  
Vol 42 (3) ◽  
pp. 265-268 ◽  
Author(s):  
María S Rodríguez-Calvo ◽  
Rosa Rico ◽  
Manuel López-Rivadulla ◽  
José M Suárez-Peñaranda ◽  
José I Muñoz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Tachycardia ◽  
Dose Range ◽  
Rare Event ◽  
Digoxin Concentration ◽  
Serum Digoxin Concentration ◽  
Toxicological Study ◽  
Digitalis Glycosides ◽  
Digoxin Intoxication ◽  
The Mean

Digoxin is a cardiotonic glycoside that is primarily used in the treatment of heart failure, atrial fibrillation or flutter, and paroxysmal atrial tachycardia. Intoxication due to digitalis excess is a common problem in clinical practice because it is therapeutically effective within a narrow dose range. However, massive intoxication with digitalis glycosides following a suicidal attempt is a rare event. In this report we describe an overdose fatality involving digoxin in a suicidal 82-year-old man, in whom measurement of serum digoxin concentration is available. A toxicological study of our patient, approximately two and a half hours after ingestion of the drug, revealed digoxin concentrations within 12.2–13.2 ng/ml in the blood, while the mean therapeutic serum concentration ranged from 0.5 to 2 ng/ml.

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