title: Differential Response to Low-Dose Dopamine or Low-Dose Nesiritide in Acute Heart Failure With Reduced or Preserved Ejection Fraction: Results From the ROSE AHF Trial (Renal Optimization Strategies Evaluation in Acute Heart Failure).
abstract: The ROSE AHF trial (Renal Optimization Strategies Evaluation in Acute Heart Failure) found that when compared with placebo, neither low-dose dopamine (2 µg/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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01132846.
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Siu-Hin
authors: SH
authors: Wan
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Susanna R
authors: SR
authors: Stevens
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Barry A
authors: BA
authors: Borlaug
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Kevin J
authors: KJ
authors: Anstrom
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Anita
authors: A
authors: Deswal
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: G Michael
authors: GM
authors: Felker
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Michael M
authors: MM
authors: Givertz
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Bradley A
authors: BA
authors: Bart
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: W H Wilson
authors: WH
authors: Tang
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.).
authors: Margaret M
authors: MM
authors: Redfield
authors: From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.-H.W., B.A.B., M.M.R., H.H.C.); Duke Clinical Research Institute, Durham, NC (S.R.S., K.J.A.); Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Duke University Medical Center and Duke Heart Center, Durham, NC (G.M.F.); Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.M.G.); Hennepin County Medical Center and Hennepin Heart Center, Minneapolis, MN (B.A.B.); and Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.H.W.T.). chen.horng@mayo.edu.
authors: Horng H
authors: HH
authors: Chen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D055316:Cystatin C / Q000097:blood*; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage* / Q000009:adverse effects; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014554:Urination / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D002316:Cardiotonic Agents; D055316:Cystatin C; D004232:Diuretics; D020097:Natriuretic Peptide, Brain; D004298:Dopamine
keywords: dopamine; heart failure; humans; incidence; kidney; natriuretic peptide, brain