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Comment & Response
June 21, 2016

Diet and Exercise for Obese Patients With Heart Failure—Reply

Author Affiliations
  • 1Wake Forest University School of Medicine, Winston-Salem, North Carolina
  • 2College of Nursing and Health Innovation, University of Texas at Arlington, Arlington
  • 3Duke University School of Medicine, Durham, North Carolina
JAMA. 2016;315(23):2619-2620. doi:10.1001/jama.2016.2924

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.

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