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Comment & Response
July 10, 2013

Aldosterone Inhibition in Patients With Heart Failure With Preserved Ejection Fraction—Reply

Author Affiliations
  • 1Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
  • 2Department of Cardiology, Medical University Graz, Graz, Austria
JAMA. 2013;310(2):205-207. doi:10.1001/jama.2013.7976

In Reply We agree that exercise stress testing may enhance diagnostic accuracy in HF with preserved EF; however, there is a lack of standardized protocols and validation. Whether an exercise stress test is superior to a standard diagnostic approach requires further research.

In contrast to peak V̇o2, V̇e/V̇co2 slope is not used as an inclusion criterion in HF trials. One study1 reported that the slope of V̇e/V̇co2 is lower in patients with HF with preserved EF vs those with HF with reduced EF, and the values from the Aldo-DHF study are in line this study. We performed a post hoc analysis stratifying patients at a V̇e/V̇co2 slope cutoff of 30. Spironolactone had no effect on peak V̇o2 (P = .35 for interaction) or E/e′ (P = .22 for interaction) when comparing subgroups above and below a V̇e/V̇co2 slope of 30.