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Comment and Response |

Aldosterone Inhibition in Patients With Heart Failure With Preserved Ejection Fraction—Reply

Frank Edelmann, MD1; Rolf Wachter, MD1; Burkert Pieske, MD2
[+] Author Affiliations
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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In Reply We agree that exercise stress testing may enhance diagnostic accuracy in HF with preserved EF; however, there is a lack of standardized protocols and validation. Whether an exercise stress test is superior to a standard diagnostic approach requires further research.

In contrast to peak V̇o2, V̇e/V̇co2 slope is not used as an inclusion criterion in HF trials. One study1 reported that the slope of V̇e/V̇co2 is lower in patients with HF with preserved EF vs those with HF with reduced EF, and the values from the Aldo-DHF study are in line this study. We performed a post hoc analysis stratifying patients at a V̇e/V̇co2 slope cutoff of 30. Spironolactone had no effect on peak V̇o2 (P = .35 for interaction) or E/e′ (P = .22 for interaction) when comparing subgroups above and below a V̇e/V̇co2 slope of 30.

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July 10, 2013
Lars H. Lund, MD, PhD; Marcus Ståhlberg, MD, PhD
1Karolinska Institutet, Stockholm, Sweden
JAMA. 2013;310(2):205. doi:10.1001/jama.2013.7967.
July 10, 2013
Christopher J. A. Neil, MBBS, FRACP; Satnam Singh, MBBC, MRCP; Michael Frenneaux, MD, FRCP, FESC
1University of Aberdeen, Aberdeen, Scotland
JAMA. 2013;310(2):204. doi:10.1001/jama.2013.7970.
July 10, 2013
Alberto Milan, MD; Sara Abram, MD; Franco Veglio, MD
1Department of Medical Sciences, University of Torino, Torino, Italy
JAMA. 2013;310(2):204-205. doi:10.1001/jama.2013.7973.
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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