IJCA-17993; No of Pages 1 International Journal of Cardiology xxx (2014) xxx
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Dopamine in acute decompensated heart failure: Does left ventricular ejection fraction matter? Jonathan R. Dalzell a,⁎, Eugene C. Connolly b a b
Scottish National Advanced Heart Failure Unit, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
a r t i c l e
i n f o
Article history: Received 29 March 2014 Accepted 4 April 2014 Available online xxxx Keywords: Acute decompensated heart failure Dopamine Ejection fraction
The Dobutamine in Acute Decompensated Heart Failure II (DAD-HF II) study [1] compared the effects of high dose furosemide alone, low dose furosemide in combination with low dose dopamine, and low dose furosemide alone in patients with acute decompensated heart failure (ADHF). In this trial, the apparent beneficial effects of dopamine that were noted in the original, and smaller, DAD-HF trial were not replicated [2]. Of note, significantly more patients with a “preserved” left ventricular ejection fraction (LVEF), i.e. N40%, were included in the DAD-HF II trial [1] compared to its predecessor [2]. Moreover, the recently reported ROSE-AHF trial [3] similarly demonstrated a neutral outcome with regard to the effect of dopamine when added to diuretic therapy. However, as with DAD-HF II, a significant proportion of patients with preserved LVEF were included in this trial, with subgroup analyses demonstrating that the effects of dopamine appear to impact more positively in those patients with a reduced LVEF [3].
There has been much recent speculation regarding the reasons for the continued failure of putative ADHF therapies [4]. A major issue is undoubtedly the heterogeneity of the population, given that ADHF patients comprise a diverse range of aetiologies, comorbidities, severity at presentation and LVEF [4]. As such, one wonders if the apparent differences between DAD-HF and DAD-HF II, along with the sub-group signals from ROSE-AHF, provide sufficient reason to worry that the net is currently being cast too broadly to answer specific questions about directed pharmacotherapy in ADHF. Should the efficacy of dopamine therefore be re-assessed in ADHF patients with reduced LVEF alone? The dichotomy of preserved versus reduced LVEF has proven crucial with regard to response to therapy in chronic HF. It would be a shame if, by arbitrarily grouping this diverse group of ADHF patients together, opportunities are being missed to advance our understanding of the ADHF spectrum and to identify any drastically needed prognosismodifying therapy. References [1] Triposkiadis FK, Butler J, Karayannis G, et al. Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: the dopamine in acute decompensated heart failure II (DAD-HF II) trial. Int J Cardiol 2014;172:115–21. [2] Giamouzis G, Butler J, Starling RC, et al. Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the dopamine in acute decompensated heart failure (DAD-HF) trial. J Card Fail 2010;16:922–30. [3] Chen HH, Anstrom KJ, Givertz MM, et al. NHLBI heart failure clinical research network. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: The ROSE acute heart failure randomized trial. JAMA 2013;310:2533–43. [4] Givertz MM, Teerlink JR, Albert NM, et al. Acute decompensated heart failure: update on new and emerging evidence and directions for future research. J Card Fail 2013;19:371–89.
⁎ Corresponding author. Tel.:+44 1413302237; fax: +44 1413306955. E-mail address: [email protected] (J.R. Dalzell).
http://dx.doi.org/10.1016/j.ijcard.2014.04.092 0167-5273/© 2014 Elsevier Ireland. Ltd
Please cite this article as: Dalzell JR, Connolly EC, Dopamine in acute decompensated heart failure: Does left ventricular ejection fraction matter?, Int J Cardiol (2014), http://dx.doi.org/10.1016/j.ijcard.2014.04.092
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Dopamine in acute decompensated heart failure: Does left ventricular ejection fraction matter? Jonathan R. Dalzell a,⁎, Eugene C. Connolly b a b
Scottish National Advanced Heart Failure Unit, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
a r t i c l e
i n f o
Article history: Received 29 March 2014 Accepted 4 April 2014 Available online xxxx Keywords: Acute decompensated heart failure Dopamine Ejection fraction
The Dobutamine in Acute Decompensated Heart Failure II (DAD-HF II) study [1] compared the effects of high dose furosemide alone, low dose furosemide in combination with low dose dopamine, and low dose furosemide alone in patients with acute decompensated heart failure (ADHF). In this trial, the apparent beneficial effects of dopamine that were noted in the original, and smaller, DAD-HF trial were not replicated [2]. Of note, significantly more patients with a “preserved” left ventricular ejection fraction (LVEF), i.e. N40%, were included in the DAD-HF II trial [1] compared to its predecessor [2]. Moreover, the recently reported ROSE-AHF trial [3] similarly demonstrated a neutral outcome with regard to the effect of dopamine when added to diuretic therapy. However, as with DAD-HF II, a significant proportion of patients with preserved LVEF were included in this trial, with subgroup analyses demonstrating that the effects of dopamine appear to impact more positively in those patients with a reduced LVEF [3].
There has been much recent speculation regarding the reasons for the continued failure of putative ADHF therapies [4]. A major issue is undoubtedly the heterogeneity of the population, given that ADHF patients comprise a diverse range of aetiologies, comorbidities, severity at presentation and LVEF [4]. As such, one wonders if the apparent differences between DAD-HF and DAD-HF II, along with the sub-group signals from ROSE-AHF, provide sufficient reason to worry that the net is currently being cast too broadly to answer specific questions about directed pharmacotherapy in ADHF. Should the efficacy of dopamine therefore be re-assessed in ADHF patients with reduced LVEF alone? The dichotomy of preserved versus reduced LVEF has proven crucial with regard to response to therapy in chronic HF. It would be a shame if, by arbitrarily grouping this diverse group of ADHF patients together, opportunities are being missed to advance our understanding of the ADHF spectrum and to identify any drastically needed prognosismodifying therapy. References [1] Triposkiadis FK, Butler J, Karayannis G, et al. Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: the dopamine in acute decompensated heart failure II (DAD-HF II) trial. Int J Cardiol 2014;172:115–21. [2] Giamouzis G, Butler J, Starling RC, et al. Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the dopamine in acute decompensated heart failure (DAD-HF) trial. J Card Fail 2010;16:922–30. [3] Chen HH, Anstrom KJ, Givertz MM, et al. NHLBI heart failure clinical research network. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: The ROSE acute heart failure randomized trial. JAMA 2013;310:2533–43. [4] Givertz MM, Teerlink JR, Albert NM, et al. Acute decompensated heart failure: update on new and emerging evidence and directions for future research. J Card Fail 2013;19:371–89.
⁎ Corresponding author. Tel.:+44 1413302237; fax: +44 1413306955. E-mail address: [email protected] (J.R. Dalzell).
http://dx.doi.org/10.1016/j.ijcard.2014.04.092 0167-5273/© 2014 Elsevier Ireland. Ltd
Please cite this article as: Dalzell JR, Connolly EC, Dopamine in acute decompensated heart failure: Does left ventricular ejection fraction matter?, Int J Cardiol (2014), http://dx.doi.org/10.1016/j.ijcard.2014.04.092
![[Heart failure with preserved left ventricular ejection fraction].](/assets/img/hold.png)
