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

Effects of ventriculoarterial coupling changes on renal function, echocardiographic indices and energy efficiency in patients with acute decompensated systolic heart failure under furosemide and dopamine treatment: A comparison of three therapeutic protocols

“…Past studies have yielded conflicting results regarding the effects of dopamine on renal function, and larger, more recent ones have been negative [13,14,[26][27][28]. However, the present study attempts an interpretation of possible dopamine renal effects by correlating them with changes induced on coupling.…”

“…Acute heart failure decompensation criteria were as follows: dyspnea with oxygen saturation b90% on admission arterial blood gas plus clinical (third heart sound or pulmonary rales N1/3 or lower extremity/sacral edema N1+ on examination) or radiological (interstitial congestion or pleural effusion on chest X-ray), or laboratory (serum B-type natriuretic peptide levels N400 ng/l) evidence of heart failure. Main exclusion criteria were: severe renal dysfunction (serum creatinine N200 μmol/l or estimated filtration rate b30 ml/min), hemodynamic instability (systolic blood pressure b90 mm Hg), tachycardia (heart rate N 100 bpm, when clinically deemed to be the cause of decompensation), suspected acute coronary syndrome on admission, severe valvular disease, complex congenital heart disease and, contrary to the Dopamine in Acute Decompensated Heart Failure I and II trials [13,14], preserved ejection function heart failure (EF N 50% [15]). Of those fulfilling both sets, only those that had been assigned to specific high dose furosemide, low dose furosemide, or a combination of furosemide and dopamine protocols by treating physicians were followed up on.…”

“…Moreover, lack of correlation of these parameters' improvement with BNP improvement suggests that results cannot be solely attributed to improved volume status (which might have improved renal function by alleviating venous congestion of nephrons). Given that studies of medications for acute heart failure have yielded relatively poor results [13,26,30], shifting treatment targeting to improving VAC status may prove beneficial.…”

İleri evre kalp yetersizliği rehberi

“…Dirençli konjesyonu olan hastalarda sıklıkla diürezi arttırmak için kullanılsa da, DAD-HF 2 çalışmasında düşük doz dobutamin yüksek doz furosemide üstün bulunmamıştır. [206] Daha yüksek dozlarda ise dopamin sırası ile β1 ve α1 reseptörlerini aktive ederek pozitif inotrop ve vazokonstriktör özel-lik gösterir. Dopaminin direk reseptör aktivite edici özelliği olsa da, majör etkisini presinaptik vezikül-lerden noradrenalin salınımını arttırarak gösterdiğini işaret eden kanıtlar mevcuttur.…”

Team-based Care for Patients Hospitalized with Heart Failure

“…51 Thiazides are known to improve diuretic responsiveness. The addition of dopamine or nesiritide to improve diuresis has not been demonstrated to be effective [52][53][54] and is not currently recommended. 5 …”