Circulation, Vol 86, 420-425, Copyright © 1992 by American Heart Association
SS Gottlieb, AC Rogowski, M Weinberg, CM Krichten, BP Hamilton and JM Hamlyn
BACKGROUND. An endogenous digitalis-like compound in mammals has long been
postulated, but only recently has a substance indistinguishable from
ouabain been identified in human plasma. Because of the potential
significance of such a substance in patients with congestive heart failure,
we sought to evaluate the pathophysiology of endogenous ouabain in these
individuals. METHODS AND RESULTS. Using an immunoassay, we determined
plasma ouabain concentrations in 51 patients with heart failure and in 19
control subjects. Plasma ouabain concentrations in control subjects ranged
from 0.16 to 0.77 nM (mean, 0.44 +/- 0.20 nM). In 19 matched heart failure
patients receiving digoxin, the mean ouabain was significantly elevated at
1.59 +/- 2.2 nM (range, 0.17-8.76 nM, p less than 0.05 versus control
subjects). The ouabain concentration correlated inversely with both cardiac
index (r = -0.62, p less than 0.005) and mean arterial pressure (r = -0.51,
p less than 0.05). However, there was no correlation between ouabain and
left ventricular filling (r = 0.19, NS) or right atrial pressures (r =
0.20, NS). In 16 heart failure patients not receiving digoxin, the mean
ouabain was 1.52 +/- 2.58 nM. No relation between renal function and
ouabain was detected. CONCLUSIONS. The unanticipated lack of correlation of
ouabain with atrial pressures indicates that volume is not the chief
determinant of ouabain concentration in patients with congestive heart
failure. However, the significant relations of plasma ouabain concentration
with cardiac index and mean arterial pressure imply that endogenous ouabain
may be an important homeostatic factor in humans.
ARTICLES
Elevated concentrations of endogenous ouabain in patients with congestive heart failure
Department of Medicine, University of Maryland School of Medicine, Baltimore 21201.
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