Diastolic Heart Failure
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《新英格兰医药杂志》
To the Editor: Aurigemma and Gaasch (Sept. 9 issue)1 do not mention diabetes mellitus as a frequent cause of diastolic heart failure. In the Strong Heart Study,2 the investigators reported an extremely high prevalence (80 percent) of left ventricular diastolic dysfunction among normotensive persons with diabetes. The relationship was independent of other confounding factors, such as blood pressure, systolic function, and age, and it was stronger for patients with worse glycemic control. Others have also reported a high frequency of diastolic dysfunction among normotensive patients with diabetes.3 Increased matrix collagen, interstitial fibrosis, myocardial microangiopathy, and myocyte hypertrophy are common findings in the diabetic heart4 that can lead to diastolic dysfunction. Tight glycemic control decreases the risk of heart failure in patients with diabetes,5 although the most appropriate treatment regimen is uncertain.
Miguel A. Arias, M.D.
Alberto Alonso, M.D.
Francisco García-Río, M.D.
Hospital Universitario La Paz
28046 Madrid, Spain
maapalomares@secardiologia.es
References
Aurigemma GP, Gaasch WH. Diastolic heart failure. N Engl J Med 2004;351:1097-1105.
Liu JE, Palmieri V, Roman MJ, et al. The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive adults: the Strong Heart Study. J Am Coll Cardiol 2001;37:1943-1949.
Boyer JK, Thanigaraj S, Schechtman KB, Perez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol 2004;93:870-875.
Hardin NJ. The myocardial and vascular pathology of diabetic cardiomyopathy. Coron Artery Dis 1996;7:99-108.
Iribarren C, Karter AJ, Go AS, et al. Glycemic control and heart failure among adult patients with diabetes. Circulation 2001;103:2668-2673.
The authors reply: Arias et al. correctly note that diabetes is an independent risk factor for congestive heart failure. Data from the Cardiovascular Health Study have also shown a significant independent relationship between diabetes and the development of congestive heart failure1; most cases of heart failure in that cohort were associated with a normal or near-normal ejection fraction — that is, they were cases of diastolic heart failure.1,2,3 We agree that aggressive control of diabetes, as well as of hypertension, should be considered an important component of the management of heart failure.
Gerard P. Aurigemma, M.D.
William H. Gaasch, M.D.
University of Massachusetts Medical School
Worcester, MA 01655
aurigemg@ummhc.org
References
Gottdiener JS, Arnold AM, Aurigemma GP, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2000;35:1628-1637.
Kitzman DW, Gardin JM, Gottdiener JS, et al. Importance of heart failure with preserved systolic function in patients > or = 65 years of age. Am J Cardiol 2001;87:413-419.
Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2001;37:1042-1048.
Miguel A. Arias, M.D.
Alberto Alonso, M.D.
Francisco García-Río, M.D.
Hospital Universitario La Paz
28046 Madrid, Spain
maapalomares@secardiologia.es
References
Aurigemma GP, Gaasch WH. Diastolic heart failure. N Engl J Med 2004;351:1097-1105.
Liu JE, Palmieri V, Roman MJ, et al. The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive adults: the Strong Heart Study. J Am Coll Cardiol 2001;37:1943-1949.
Boyer JK, Thanigaraj S, Schechtman KB, Perez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol 2004;93:870-875.
Hardin NJ. The myocardial and vascular pathology of diabetic cardiomyopathy. Coron Artery Dis 1996;7:99-108.
Iribarren C, Karter AJ, Go AS, et al. Glycemic control and heart failure among adult patients with diabetes. Circulation 2001;103:2668-2673.
The authors reply: Arias et al. correctly note that diabetes is an independent risk factor for congestive heart failure. Data from the Cardiovascular Health Study have also shown a significant independent relationship between diabetes and the development of congestive heart failure1; most cases of heart failure in that cohort were associated with a normal or near-normal ejection fraction — that is, they were cases of diastolic heart failure.1,2,3 We agree that aggressive control of diabetes, as well as of hypertension, should be considered an important component of the management of heart failure.
Gerard P. Aurigemma, M.D.
William H. Gaasch, M.D.
University of Massachusetts Medical School
Worcester, MA 01655
aurigemg@ummhc.org
References
Gottdiener JS, Arnold AM, Aurigemma GP, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2000;35:1628-1637.
Kitzman DW, Gardin JM, Gottdiener JS, et al. Importance of heart failure with preserved systolic function in patients > or = 65 years of age. Am J Cardiol 2001;87:413-419.
Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2001;37:1042-1048.