- 作者：Filippos K. Triposkiadis ; Javed Butler ; Georgios Karayannis ; R ; all C. Starling ; Gerasimos Filippatos ; Kathy Wolski ; John Parissis ; Charalabos Parisis ; Dimitrios Rovithis ; Konstantinos Koutrakis ; John Skoularigis ; Christos-Konstantinos Antoniou ; Christina Chrysohoou ; Christos Pitsavos ; Christodoulos Stefanadis ; John Nastas ; Themistoklis Tsaknakis ; Lilian Mantziari ; Georgios Giannakoulas ; Haralambos Karvounis ; Andreas P. Kalogeropoulos ; et al.
- 关键词：Acute heart failure ; Furosemide ; Dopamine ; Worsening renal function
- 刊名：International Journal of Cardiology
- 出版年：1 March, 2014
- 年：2014
- 卷：172
- 期：1
- 页码：115-121
- 全文大小：581 K
Aims
The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population.Methods and results
161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n = 50, 20 mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n = 56, 5 mg/h and 5 渭g kg鈭?#xA0;1 min鈭?#xA0;1 respectively), or c) low-dose furosemide (LDF, n = 55, furosemide 5 mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) 鈮?#xA0;0.3 mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24 h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P = 0.74) or at one year (38.1%, 33.9% and 32.7%, P = 0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P = 0.55) or one year (60.0%, 50.0%, and 47%, P = 0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P < 0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P = 0.27). No significant differences in adverse events were noted.
Conclusions
In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.