Abstract| Volume 23, ISSUE 11, P831, November 2017

Randomized Evaluation of Heart Failure with Preserved Ejection Fraction Patients with Acute Heart Failure and Dopamine (Ropa-Dop) Trial

      Introduction: Heart failure preserved with ejection fraction (HFpEF) constitutes half of HF hospitalizations today, however there is little prospective data to guide management of acute decompensated heart failure (ADHF) in this population. Hypothesis: We hypothesized that low-dose dopamine (DA) may enhance decongestion while preserving renal function in HFpEF patients in ADHF. Methods: In a prospective, randomized trial, we assigned 90 HFpEF patients presenting with ADHF to receive one of four treatments within 24 hours of hospitalization: (1) intravenous furosemide administered every 12 hrs (IF), (2) continuous infusion furosemide (CF); (3) intermittent bolus furosemide with low-dose DA (3 mcg/kg/min, IF + DA); (4) continuous infusion furosemide with low-dose DA (CF + DA). The treatment duration was 72 hours. The recommended diuretic dosing was at least 2.0 times the prior oral dose. The primary endpoint was percent change in creatinine from baseline to 72 hours. Secondary endpoints included worsening renal function (WRF), defined as rise in creatinine by 0.3 mg/dL at 72 hrs, and volume of diuresis at 72 hrs. Linear regression and logistic regression analyses were performed for the outcomes of interest, with tests for interaction between diuretic and DA strategies. Results: The overall cohort was characterized by: mean age 66 years (SD ±13), 68% women, 62% black, with mean creatinine 1.3 mg/dL (IQR 0.9–1.7). In comparing the IF v. CF treatment arms (Table 1), CF was associated with higher % increase creatinine (11.15; 95% CI: 0.92, 21.37) and higher OR for development of WRF (OR 4.32; 95% CI: 1.26, 14.74), in regression analyses, with no difference in volume of diuresis. In comparing the DA v. no DA treatment arms, there were no significant differences in % change creatinine or development of WRF, however the DA arm was associated with greater volume of diuresis (988 mL, 95% CI: 240 mL, 1736 mL). No significant interaction was seen between diuretic strategy and DA (P > .7). Conclusion: In HFpEF patients with ADHF, CF was associated with higher % increase creatinine and higher odds of WRF in regression models, without a significant difference in volume of diuresis. DA had no significant impact on renal function and was associated with greater volume of diuresis at 72 hrs. Low dose DA may be considered in the management of acute HFpEF to augment diuresis, whereas CF should be avoided in these patients.
      Table 1Renal Function and Diuresis Outcomes by Diuretic Strategy and Vasopressor Strategy
      Diuretic Strategy Intermittent Furosemide Continuous Furosemide P value
      % Increase in Cr

      (Linear Regression)
      0.0 (REF) 11.15

      (0.92, 21.37)
      WRF (Creat ↑ 0.3)

      (OR, Logistic Regression)
      1.0 (REF) 4.32

      (1.26, 14.74)
      Volume of Diuresis

      (Linear Regression)
      0.0 (REF) 534.70

      (−278.79, 1348.19)
      Dopamine Strategy No Dopamine Dopamine P value
      % Increase in Cr

      (Linear Regression)
      0.0 (REF) 4.80

      (−5.15, 14.75)
      WRF (Creat ↑ 0.3)

      (OR, Logistic Regression)
      1.0 (REF 1.09 (0.38, 3.10) .87
      Volume of Diuresis

      (Linear Regression)
      0.00 (REF) 988.07

      (240.13, 1736.01)
      Model adjusted for age, race, gender, current smoking, hypertension, diabetes, atrial fibrillation, baseline eGFR, change in SBP over 72 hours, change in heart rate over 72 hours.
      WRF = worsening renal function; OR = Odds ratio.
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