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Modified SAMe-TT2R2 score for predicting the therapeutic range of digoxin

Modifizierter SAMe-TT2R2-Score zur Vorhersage der therapeutischen Breite von Digoxin

Herz volume 46, pages 359–366 (2021)Cite this article

Abstract

Background

Digoxin treatment has come under scrutiny in recent years after reports from several studies that it is associated with increased mortality in patients with atrial fibrillation (AF). The clinical effects of digoxin on mortality were closely related to serum digoxin concentrations (SDC) in these studies. In the present work, we evaluated the role of the SAMe-TT2R2 and modified SAMe-TT2R2 scores in predicting the therapeutic range of digoxin therapy.

Methods

Medical records from our institution were screened for patients who were under digoxin treatment between 2008 and 2018. A total of 2418 patients for whom SDC were recorded were included in the study. An SDC of <0.5 or >1.2 ng/ml was defined as being out of the therapeutic range (oTR).

Results

In multivariable regression analyses, abnormal body mass index (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.29–1.95, p < 0.01), white blood cell count (OR: 1.12, 95% CI: 1.01–1.27, p < 0.01), and the modified SAMe-TT2R2 score (OR: 4.19 95% CI: 3.71–4.72, p < 0.01) were determined to be independent predictors of oTR. A modified SAMe-TT2R2 score greater than 3 predicted oTR with a sensitivity of 86% and a specificity of 65% (AUC: 0.825, p < 0.01).

Conclusion

Digoxin is still widely used in the treatment of heart failure and AF despite concerns about the increased risk of mortality when levels are oTR. In the present study, the modified SAMe-TT2R2 score was found to be an independent predictor of oTR. This score may aid clinicians in identifying patients who are more likely to benefit from digoxin therapy.

Zusammenfassung

Hintergrund

In den letzten Jahren wurde die Digoxintherapie kritisch betrachtet, nachdem verschiedene Studien über einen Zusammenhang mit erhöhter Mortalität bei Patient(inn)en mit Vorhofflimmern (VF) berichtet hatten. Die klinischen Wirkungen von Digoxin auf die Mortalität waren eng mit den Serumdigoxinkonzentrationen (SDC) in diesen Studien verknüpft. In der vorliegenden Arbeit untersuchten die Autor(inn)en die Rolle des SAMe-TT2R2-Scores und des modifizierten SAMe-TT2R2-Scores zur Vorhersage der therapeutischen Breite der Therapie mit Digoxin.

Methoden

Die Krankenakten der Klinik der Autor(inn)en wurden auf Patient(inn)en hin durchsucht, die zwischen 2008 und 2018 mit Digoxin behandelt wurden. In die Studie wurden 2418 Patient(inn)en einbezogen, für welche die SDC dokumentiert waren. Eine SDC von <0,5 oder >1,2 ng/ml wurde als außerhalb der therapeutischen Breite liegend definiert.

Ergebnisse

In multivariablen Regressionsanalysen wurden ein anomaler Body Mass Index (Odds Ratio, OR: 1,59; 95 %-Konfidenzintervall, 95 %-KI: 1,29–1,95; p < 0,01), die Leukozytenzahl (OR: 1,12; 95 %-KI: 1,01–1,27; p < 0,01) und der modifizierte SAMe-TT2R2-Score (OR: 4,19; 95 %-KI: 3,71–4,72; p < 0,01) als unabhängige Prädiktoren eines Werts außerhalb der therapeutischen Breite ermittelt. Ein modifizierter SAMe-TT2R2-Score >3 sagte einen Wert außerhalb der therapeutischen Breite mit einer Sensitivität von 86 % und einer Spezifität von 65 % (AUC: 0,825; p < 0,01) voraus.

Schlussfolgerung

Weiterhin ist Digoxin zur Therapie der Herzinsuffizienz und des VF weit verbreitet – trotz Bedenken hinsichtlich des erhöhten Mortalitätsrisikos, wenn die Spiegel außerhalb der therapeutischen Breite liegen. In der vorliegenden Studie erwies sich der modifizierte SAMe-TT2R2-Score als unabhängiger Prädiktor eines Werts außerhalb der therapeutischen Breite. Dieser Score kann Klinikärzt(inn)en dabei helfen, Patient(inn)en zu erkennen, die mit höherer Wahrscheinlichkeit Vorteile von einer Digoxintherapie haben.

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Affiliations

  1. Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey

    Mehmet Baran Karataş, Yiğit Çanga MD, Nizamettin Selçuk Yelgeç, Ahmet Zengin, Özge Güzelburç, Semih Eren & Ayşe Emre

  2. Siyami Ersek Hospital, Tıbbıye street, Istanbul, Uskudar, Turkey

    Yiğit Çanga MD

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  1. Mehmet Baran Karataş
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  2. Yiğit Çanga MD
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  3. Nizamettin Selçuk Yelgeç
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Correspondence to Yiğit Çanga MD.

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Conflict of interest

M.B. Karataş, Y. Çanga, N.S. Yelgeç, A. Zengin, Ö. Güzelburç, S. Eren and A. Emre declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements.

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Karataş, M.B., Çanga, Y., Yelgeç, N.S. et al. Modified SAMe-TT2R2 score for predicting the therapeutic range of digoxin. Herz 46, 359–366 (2021). https://doi.org/10.1007/s00059-020-04965-5

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  • DOI: https://doi.org/10.1007/s00059-020-04965-5

Keywords

  • Atrial fibrillation
  • Cardiac glycosides
  • Heart failure
  • Vitamin K antagonists
  • Anticoagulants

Schlüsselwörter

  • Vorhofflimmern
  • Herzglykoside
  • Herzinsuffizienz
  • Vitamin-K-Antagonisten
  • Antikoagulanzien