title: 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.
abstract: BACKGROUND
  Ventriculoarterial coupling (VAC) status relates to tissue perfusion and its optimization may improve organ function and energy efficiency (EE) of the cardiovascular system. The effects of non-invasively calculated VAC improvement on echocardiographic parameters, renal function indices and EE improvement in patients with acute decompensated systolic heart failure were studied. Furthermore, effects of different treatment modalities on VAC, renal function and echocardiographic parameters were compared.
  
  
  METHODS
  Systolic heart failure patients with ejection fraction <50% were studied, who, at the treating physician's discretion, received 8-hour infusions of: high dose furosemide (20mg/h), low dose furosemide (5mg/h) or dopamine (5μg/kg/min) combined with furosemide (5mg/h). Echocardiographic assessments were performed at 0 and 24h. Renal function was evaluated using serum creatinine and creatinine clearance. VAC and EE were assessed noninvasively, by echocardiography.
  
  
  RESULTS
  Significant correlations were noted between VAC improvement and improvements in EE and serum creatinine (rho=0.96, p<0.001, rho=0.32, p=0.04 respectively). Dopamine-furosemide combination had a borderline effect on creatinine (p=0.08) and led to significant improvements in e', E/e' ratio (p=0.015 and p=0.009 respectively) and VAC (value closer to 1).
  
  
  CONCLUSIONS
  VAC improvement correlated with EE and creatinine improvement, regardless of treatment, supporting a potential role for VAC status assessment and improvement in acute decompensated systolic heart failure. Dopamine and furosemide combination seemed to improve VAC and diastolic function but only had a borderline effect on renal function.
authors.affiliation: First Department of Cardiology, Hippokration General Hospital, Athens Medical School, 114 Vasilissis Sofias ave. Athens 11527, Greece.
authors.forename: Christos-Konstantinos
authors.initials: CK
authors.lastname: Antoniou
authors.affiliation: First Department of Cardiology, Hippokration General Hospital, Athens Medical School, 114 Vasilissis Sofias ave. Athens 11527, Greece. Electronic address: chrysohoou@usa.net.
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.affiliation: Emory University Hospital, Cardiac Imaging Center, Department of Medicine, Division of Cardiology, 1365 Clifton Road, NE - AT507, Atlanta, GA 30322, USA.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.affiliation: First Department of Cardiology, Hippokration General Hospital, Athens Medical School, 114 Vasilissis Sofias ave. Athens 11527, Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Manolakou
authors.affiliation: First Department of Cardiology, Hippokration General Hospital, Athens Medical School, 114 Vasilissis Sofias ave. Athens 11527, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
authors.affiliation: First Department of Cardiology, Hippokration General Hospital, Athens Medical School, 114 Vasilissis Sofias ave. Athens 11527, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsioufis
authors.affiliation: First Department of Cardiology, Hippokration General Hospital, Athens Medical School, 114 Vasilissis Sofias ave. Athens 11527, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: First Department of Cardiology, Hippokration General Hospital, Athens Medical School, 114 Vasilissis Sofias ave. Athens 11527, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D000208:Acute Disease; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage; D004298:Dopamine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage*; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology*; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D004232:Diuretics; D005665:Furosemide; D004298:Dopamine
keywords: Acute decompensated systolic heart failure; Dopamine; Echocardiography; Furosemide; Renal function; Ventriculoarterial coupling