Optimal decongestive therapy in acute decompensated heart failure syndromes: far from being solved.

We have read with great interest the article entitled “Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: The Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) Trial” [1]. First, we would like to commend the authors for their effort in carrying out this investigator-initiated clinical trial by testing the prognostic effect of three decongestive strategies in the management of patients with acute decompensated heart failure (ADHF). The analysis of the data revealed no-significant differences in the in-hospital and post-discharge outcomes between high (HDF) vs low-dose furosemide infusion (LDFD); the addition of low-dose dopamine infusion to LDFD-groupwas not associatedwith any beneficial effects. Not infrequently, trials comparing different decongestive modalities in ADHF have produced negative results [2–4] leading to a great uncertainty about the optimal treatment in ADHF syndromes.Wewould like to highlight some potential explanations for these and other recent findings and also, exert caution in their interpretation.