To the Editor.
—We would like to commend Dr Gaasch1 for his excellent review on heart failure due to systolic and diastolic dysfunction. However, he recommends that symptomatic diastolic dysfunction be treated with β-adrenergic blockers or calcium channel blockers (CCBs). While we generally agree with this recommendation, we believe that further clarification is warranted. In the article, the statement was made that "negative chronotropic agents that slow the heart rate are the preferred therapeutic agents" and we fully support this recommendation. However, in Table 2 and in the explanation of the table, the blanket statement is made that β-blockers or CCBs should be used to treat symptomatic left ventricular dysfunction with normal ejection fraction (diastolic dysfunction).1In diastolic dysfunction, there is impaired filling and reduced diastolic relaxation of the left ventricle due to increased stiffness.2 Tachycardia can cause increased diastolic wall tension and may worsen diastolic heart
Mehra IV, Weart CW. Diagnosis and Treatment of Heart Failure Due to Left Ventricular Dysfunction. JAMA. 1994;272(17):1324-1325. doi:10.1001/jama.1994.03520170034020