Use of Low Dose Dopamine in Heart Failure with Preserved Ejection Fraction Patients with Right Ventricular Dysfunction

PURPOSE: Right ventricular dysfunction (RVD) is associated with poor outcomes in heart failure with preserved ejection fraction (HFpEF) and serves as an important therapeutic target. Though treatment with low-dose dopamine (DA) has not shown benefit decompensated HF, we sought to evaluate the effect of DA on HFpEF patients with RVD (HFpEF-RVD), which is currently is unknown. METHODS: We analyzed subjects enrolled in the Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine trial (NCT01901809) for the presence of RVD and compared clinical outcomes based on treatment with DA. RVD was defined by ≥1 trait on echocardiography: tricuspid annular plane systolic excursion <1.7 cm, fractional area change <35%, tissue Doppler imaging velocity (S') <10 cm/s, or semi-quantitative visual assessment of RVD. Bivariable analysis was performed using median tests for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression was performed to assess for predictors of RVD in our cohort. RESULTS: RVD was present in 29% (24 of 82) of our cohort. HFpEF-RVD patients had lower BMI (34 kg/m2 [14.6] v 42 kg/m2 [14.2], p=0.01), higher Cr (1.4 mg/dL [0.6] v 1.2 mg/dL [1], p=0.01), and higher NT-proBNP (2327 pg/mL [3260] v 1425 pg/mL [2370], p=0.002) compared to HFpEF-no RVD. BMI was inversely associated with HFpEF-RVD after adjustment for age, sex, and race (p=0.02). HFpEF-RVD had increased 30-D hospital readmission (35% v 19%, p=0.12) and worse survival at 1 year (70% v 88%, p=0.06), though not statistically significant. DA had no significant effect on renal function in HFpEF-RVD; however, the presence of RVD positively modified the effect of DA on length of stay (LOS) (p=0.01, Figure). CONCLUSION: HFpEF-RVD reflects a sicker subgroup of HFpEF patients. In hospitalized HFpEF, low-dose DA was associated with shorter LOS in HFpEF-RVD. Future studies should be performed to find useful therapies in HFpEF-RVD.

Duke Scholars

Author Stuart Dean Russell Medicine, Cardiology