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

Abstract

Introduction Heart failure with preserved ejection fraction (HFpEF) constitutes half of HF hospitalizations in the U.S. Right ventricular dysfunction (RVD) is associated with high morbidity and mortality in HFpEF and serves as an important therapeutic target. The use of low-dose dopamine (DA) has not shown benefit in the treatment of decompensated HF patients; however, the effect of DA on HFpEF patients with RVD (HFpEF-RVD) 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 (ROPA-DOP; NCT01901809) for the presence of RVD and compared clinical outcomes based on treatment assignment to DA. ROPA-DOP was a randomized controlled trial of low-dose DA for the treatment of acute decompensated HFpEF. RVD was defined as at least 1 of the following by echocardiography: tricuspid annular plane systolic excursion Results RVD was present in 29% (24 of 82) of patients enrolled in the ROPA-DOP trial. 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 1.15 mg/dL [1], p=0.01), higher admission NT-proBNP (2327 pg/mL [3260] v 1425 pg/mL [2370], p=0.002), and more atrial fibrillation (54% v 29%, p=0.03) compared to HFpEF without RVD. BMI remained inversely associated with HFpEF-RVD after adjustment for age, sex, and race (p=0.02). HFpEF-RVD trended towards increased all-cause 30-D hospital readmission (34.8% v 19%, p=0.12) and worse survival at 1 year (70% v 87.5%, p=0.06). DA had no significant effect on urine output, weight change, or renal function in HFpEF-RVD; however, DA was associated with shorter hospital length of stay (LOS) in HFpEF-RVD in testing for interaction effects between RVD and DA (p=0.01, Figure). Conclusion HFpEF-RVD reflects a sicker subgroup of HFpEF patients. Amongst hospitalized HFpEF, low-dose dopamine was associated with shorter LOS in HFpEF-RVD. Future studies should be performed to find useful therapies in this subgroup of HFpEF.