Impact of Digoxin Therapy on Cardiac Mechanical Dyssynchrony in Patients with Non-ischemic Heart Failure

Background and Aim: Mechanical dyssynchrony is a key determinant of impaired cardiac performance, adverse remodeling, and prognosis in heart failure (HF).Digoxin is widely used in HF because of its positive inotropic and neurohormonal effects; however, its impact on mechanical dyssynchrony remains poorly defined. Materials and Methods:In this prospective, randomized, single-center study, 50 patients with newly diagnosed non-ischemic dilated cardiomyopathy, left ventricular ejection fraction (LVEF) <45%, and documented mechanical dyssynchrony by tissue Doppler imaging were randomized to guideline-directed medical therapy (GDMT) alone (control) or GDMT plus digoxin (0.125-0.25 mg/day).Echocardiographic parameters, including intraventricular and interventricular dyssynchrony, left ventricular volumes, LVEF, and QRS duration, were assessed at baseline and at three months.Results: At three months, intraventricular dyssynchrony decreased significantly in both groups, with a greater reduction in the digoxin group (P < 0.001 within-group; P = 0.044 between-group).Interventricular dyssynchrony improved significantly only in the digoxin group (P = 0.002).Digoxin therapy was associated with increased LVEF (P = 0.006), reduced left ventricular volumes, and shorter QRS duration (P < 0.001).No significant changes were observed in the control group for these parameters.Conclusion: Digoxin therapy appears to improve cardiac mechanical synchrony, systolic function, and electrical conduction in patients with nonischemic HF.These findings suggest that the therapeutic effects of digoxin may extend beyond symptom relief and neurohormonal modulation to include favorable mechanical remodeling.