In Reply The elegant study by Dr Farmakis and colleagues of electrical stimulation provided the most definitive evidence that skeletal muscle abnormalities are important contributors to severe exercise intolerance, which is the primary manifestation of chronic HFPEF, and suggested that skeletal muscle abnormalities are promising therapeutic targets. This was a key premise of our trial.
In addition to meeting 2 sets of diagnostic criteria commonly used in heart failure studies, all our patients also met both the current US1 and European HFPEF criteria. Ninety-six percent of patients had abnormal diastolic filling patterns, mean e′ was moderately reduced (6.2 cm/s), and E/e′ was significantly increased (mean, 13.2). Most had left ventricular hypertrophy by echocardiography.
Kitzman DW, Haykowsky MJ, Kraus W. Diet and Exercise for Obese Patients With Heart Failure—Reply. JAMA. 2016;315(23):2619-2620. doi:10.1001/jama.2016.2924