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November 2, 1994

Diagnosis and Treatment of Heart Failure Due to Left Ventricular Dysfunction-Reply

Author Affiliations

Lahey Clinic Burlington, Mass

JAMA. 1994;272(17):1325. doi:10.1001/jama.1994.03520170034021

In Reply.  —A primary purpose of my review was to emphasize the importance of treating patients with left ventricular dysfunction—whether or not they have symptoms. I discussed the impact of large randomized trials that were directed at the treatment of systolic dysfunction and pointed out that there are no similar trials in patients with diastolic dysfunction. Until such studies are performed there will be diverse opinions on the therapeutic options and the relative roles of β-blockers, CCBs, and other agents in the treatment of left ventricular diastolic dysfunction. Despite a lack of such data, we agree that negative chronotropic agents are beneficial in most patients with symptomatic diastolic dysfunction. I generally prefer verapamil, but if this is not tolerated, a β-blocker can be an alternative. Slowing the heart rate can have a beneficial effect on myocardial energetics; the myocardial oxygen requirement is decreased and coronary filling time is increased. If

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