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Comment and Response |

Aldosterone Inhibition in Patients With Heart Failure With Preserved Ejection Fraction

Lars H. Lund, MD, PhD1; Marcus Ståhlberg, MD, PhD1
[+] Author Affiliations
1Karolinska Institutet, Stockholm, Sweden
JAMA. 2013;310(2):205. doi:10.1001/jama.2013.7967.
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To the Editor The Aldo-DHF trial1 (similar to other trials in HF with preserved EF2,3) failed to demonstrate a benefit from neurohormonal antagonism. We are concerned about the inclusion criteria and power of the study.

Did patients in the Aldo-DHF study actually have diastolic HF? The salient inclusion criterion was diastolic dysfunction. However, this was mild (mostly grade 1) and occurred in the healthy elderly population, and therefore does not equate with diastolic HF. Nonspecific symptoms (fatigue and nocturia) and signs (eg, peripheral edema) were common, whereas specific symptoms (eg, paroxysmal nocturnal dyspnea) and signs (eg, rales) were less common or not reported. We wonder if the diastolic dysfunction criterion led to recruitment skewed toward echocardiographic rather than clinical findings.

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July 10, 2013
Frank Edelmann, MD; Rolf Wachter, MD; Burkert Pieske, MD
1Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
2Department of Cardiology, Medical University Graz, Graz, Austria
JAMA. 2013;310(2):205-207. doi:10.1001/jama.2013.7976.
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