CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Srikanth Sola, MD and
Bobby V. Khan, MD, PhD*
* Emory University School of Medicine, Cardiology, 69 Jesse Hill Drive SE, C233, Atlanta, Georgia 30303 (Email: bkhan{at}emory.edu).
We thank Drs. Bahl and Chongtham for their interest in our study on the effects of atorvastatin on systolic function and markers of inflammation in patients with nonischemic heart failure (HF) (1). We agree with them that nonischemic HF represents a heterogeneous condition with various etiologies. The authors correctly point out that duration of illness is an important determinant in response to therapy in patients with nonischemic HF. Patients with newly diagnosed nonischemic HF, for example, may have myocarditis with transient left ventricular (LV) systolic function followed by a spontaneous improvement in ventricular function, regardless of medical therapy.
We disagree, however, that patients in this trial should have been randomized according to duration of illness. The inclusion criteria for this study required that patients on stable HF medications for at least three months before study entry, effectively excluding patients with more transient forms of nonischemic HF that may be likely to resolve spontaneously. Moreover, we believe that other factors play a much more important role in determining response to therapy and long-term prognosis in these patients. For example, Felker et al. (2) followed 1,230 patients with nonischemic HF for an average of 4.4 years and found that older age, male gender, and etiology of HF were associated with increased mortality. Other teams have demonstrated that prognosis in this group of patients is primarily determined by age, LV ejection fraction, and symptomatic HF (3,4).
In conclusion, our study demonstrated that therapy with atorvastatin improved LV systolic function and markers of inflammation in patients with chronic forms of nonischemic HF—results that we believe were relatively unbiased by duration of illness.
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References
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- Sola S, Mir MQS, Lerakis S, Tandon N, Khan BV. Atorvastatin improves left ventricular systolic function and serum markers of inflammation in non-ischemic heart failure J Am Coll Cardiol 2006;47:332-337.[Abstract/Free Full Text]
- Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy N Engl J Med 2000;342:1077-1084.[Abstract/Free Full Text]
- Bard BA, Shaw LK, McCants CB, et al. Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy J Am Coll Cardiol 1997;30:1002-1008.[Abstract]
- Felker GM, Jaeger CJ, Klodas E. Myocarditis and long-term survival in peripartum cardiomyopathy Am Heart J 2000;140:785-791.[CrossRef][ISI][Medline]
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