Inclusion Criteria:  Admitted to hospital with a principal diagnosis of ADHF BMI adjusted BNP ≥ 500 pg/mL or NT-proBNP ≥ 2000 pg/mL LVEF ≤ 45% At least one sign/symptom of fluid overload  At least one of the following:  inadequate diuretic response least one sign or symptom of low perfusion  Exclusion Criteria:  First IV treatment upon presentation in hospital to randomization > 48 hours Received an inotrope or anticipated to receive an inotrope in the 12 hours following enrollment Requires mechanical support or anticipated to receive mechanical support in the 12 hours following enrollment Systolic blood pressure < 80mmHg or > 130mmHg Symptomatic hypotension eGFR < 25 mL/min/1.732