Differential response to low-dose dopamine or low-dose nesiritide in acute heart failure with reduced or preserved ejection fraction

Siu Hin Wan, Susanna R. Stevens, Barry A. Borlaug, Kevin J. Anstrom, Anita Deswal, G. Michael Felker, Michael M. Givertz, Bradley A. Bart, W. H Wilson Tang, Margaret M. Redfield, Horng H. Chen

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Background - The ROSE AHF trial (Renal Optimization Strategies Evaluation in Acute Heart Failure) found that when compared with placebo, neither low-dose dopamine (2 g/kg per minute) nor low-dose nesiritide (0.005 μg/kg per minute without bolus) enhanced decongestion or preserved renal function in AHF patients with renal dysfunction. However, there may be differential responses to vasoactive agents in AHF patients with reduced versus preserved ejection fraction (EF). This post hoc analysis examined potential interaction between treatment effect and EF (EF ≤40% versus >40%) on the ROSE AHF end points. Methods and Results - ROSE AHF enrolled AHF patients (n=360; any EF) with renal dysfunction. The coprimary end points were cumulative urine volume and the change in serum cystatin-C in 72 hours. The effect of dopamine (interaction P=0.001) and nesiritide (interaction P=0.039) on urine volume varied by EF group. In heart failure with reduced EF, urine volume was higher with active treatment versus placebo, whereas in heart failure with preserved EF, urine volume was lower with active treatment. The effect of dopamine and nesiritide on weight change, sodium excretion, and incidence of AHF treatment failure also varied by EF group (interaction P<0.05 for all). There was no interaction between vasoactive treatment's effect and EF on change in cystatin-C. Compared with placebo, dopamine was associated with improved clinical outcomes in heart failure with reduced EF and worse clinical outcomes in heart failure with preserved EF. With nesiritide, there were no differences in clinical outcomes when compared with placebo in both heart failure with reduced EF and heart failure with preserved EF. Conclusions - In this post hoc analysis of ROSE AHF, the response to vasoactive therapies differed in patients with heart failure with reduced EF and heart failure with preserved EF. Investigations of AHF therapies should assess the potential for differential responses in AHF with preserved versus reduced EF. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT01132846.

Original languageEnglish (US)
Article numbere002593
JournalCirculation: Heart Failure
Issue number8
StatePublished - Aug 1 2016

Bibliographical note

Funding Information:
This study was supported by grants from the National Heart, Lung, and Blood Institute: Coordinating Center: U10 HL084904; Regional Clinical Centers: U01 HL084861, U10 HL110312, U109 HL110337, U01 HL084889, U01HL084890, U01 HL084891, U10 L110342, U10 HL110262, U01 HL084931, U10 HL110297,U10 HL110302, U10 HL110309, U10 HL110336, and U10 HL110338. This work is also supported by the National Center for Advancing Translational Sciences (NCATS): UL1TR000454, UL1 TR000135, UL1RR025008, and UL1TR 000439 and the National Institute on Minority Health and Health Disparities (NIMHD): 8 U54 MD007588.

Publisher Copyright:
© 2016 American Heart Association, Inc.


  • dopamine
  • heart failure
  • humans
  • incidence
  • kidney
  • natriuretic peptide, brain


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