To the Editor The Aldosterone Receptor Blockade in Diastolic Heart Failure
(Aldo-DHF) study1 tested the hypothesis that aldosterone
inhibition with spironolactone would result in improvement in maximum exercise capacity (peak
V̇o2) or diastolic function (E/e′), each a co-primary end point.
Whereas resting E/e′ was reduced by spironolactone, exercise capacity was not. The method of
patient selection may have contributed to a false-negative result. We believe that this study
illustrates the fundamental problems with the current concept of heart failure (HF) with preserved
ejection fraction (EF) and, in particular, the role of exercise in this syndrome.
Neil CJA, Singh S, Frenneaux M. Aldosterone Inhibition in Patients With Heart Failure With Preserved Ejection
Fraction. JAMA. 2013;310(2):204. doi:10.1001/jama.2013.7970