CORRESPONDENCE: LETTER TO THE EDITOR
Atorvastatin in Nonischemic Left Ventricular Systolic Dysfunction
Ajay Bahl, MD, DNB, MRCP, DM* and
Dhanaraj Singh Chongtham, MD
* Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India (Email: drajaybahl{at}hotmail.com).
Sola et al. (1) found that atorvastatin improved left ventricular (LV) ejection fraction and reduced LV end diastolic dimensions in patients with nonischemic heart failure (HF) (1). Nonischemic HF is a heterogeneous condition with a variable clinical course. One of the most important determinants of response to therapy is the duration of illness. Patients with recent-onset HF due to dilated cardiomyopathy and myocarditis have a variable clinical course, with the most dramatic changes in LV function. They frequently have spontaneous improvements as well as deteriorations in LV function (2,3). In contrast, patients with long-standing disease are likely to have relatively smaller changes in LV function spontaneously and in response to therapy. Patients in this study were not randomized for the duration of illness, a very important variable. Duration of illness may even out and not be so important a factor in the large megatrials of HF therapy. However, in this small study of 108 patients this important confounding variable can introduce bias. Patients in any small study on therapeutic responses to therapy in nonischemic HF must also be randomized for the duration of illness.
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1. Sola S, Mir MQS, Lerakis S, Tandon N, Khan BV. Atorvastatin improves left ventricular systolic function and serum markers of inflammation in nonischemic heart failure J Am Coll Cardiol 2006;47:332-337.[Abstract/Free Full Text]2. Dec GW, Fuster V. Idiopathic dilated cardiomyopathy N Engl J Med 1994;331:1564-1575.[Free Full Text] 3. Dec Jr GW, Palacios IF, Fallon JT, et al. Active myocarditis in the spectrum of acute dilated cardiomyopathiesClinical features, histologic correlates, and clinical outcome. N Engl J Med 1985;312:885-890.[Abstract]
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