Correspondence

Diastolic Heart Failure

N Engl J Med 2005; 352:307-308January 20, 2005

Article

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

5 References

1
Aurigemma GP, Gaasch WH. Diastolic heart failure. N Engl J Med 2004;351:1097-1105
Full Text | Web of Science | Medline

2
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
CrossRef | Web of Science | Medline

3
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
CrossRef | Web of Science | Medline

4
Hardin NJ. The myocardial and vascular pathology of diabetic cardiomyopathy. Coron Artery Dis 1996;7:99-108
CrossRef | Web of Science | Medline

5
Iribarren C, Karter AJ, Go AS, et al. Glycemic control and heart failure among adult patients with diabetes. Circulation 2001;103:2668-2673
Web of Science | Medline

Author/Editor Response

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.1-3 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

3 References

1
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
CrossRef | Web of Science | Medline

2
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
CrossRef | Web of Science | Medline

3
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
CrossRef | Web of Science | Medline

Citing Articles (1)