Assessment of Diastolic Dysfunction: Drugs Could alter the Results

To the Editor, We read with great interest the article by El Aouar et al.1, entitled "Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients", which was published in the previous issue of Arquivos Brasileiros de Cardiologia. The authors1 aimed to evaluate the relationship between left atrial volume index and different grades of diastolic dysfunction in Brazilian patients submitted to echocardiogram. Although we commend the authors for the detailed and valuable information that they have provided, some comments may be beneficial. Diastolic dysfunction is associated with adverse outcomes and its prevalence among hypertensive, hyperlipidemic and diabetic adults is very high2. It has been shown that lowering blood pressure and heart rate, management of impaired lipid profile and blood glucose could improve diastolic dysfunction2. Also, thyroid dysfunction has been associated with the development of diastolic dysfunction even in patients without underlying heart disease3. Diuretics, ACE inhibitors and angiotension-II receptor antagonists, nitrates and their derivatives, calcium channel blockers, alpha-blockers, nicardipine and phosphodiesterase inhibitors reduce left ventricular filling pressures2,3. Statins could ameliorate diastolic dysfunction by attenuating myocardial interstitial fibrosis and angiogenesis independently of their lipid lowering effects4. Thyroid hormonotherapies increase cardiac output by affecting stroke volume and heart rate, and reduce systemic vascular resistance by activating the renin-angiotensin-aldosterone system; resulting in an improvement in diastolic dysfunction3. It has been demonstrated in diabetic cardiomyopathy that eplerenone, the mineralocorticoid receptor blocker, has anti-fibrotic effects which could attenuate cardiac steatosis, apoptosis and remodelling as well as diastolic dysfunction5. In conclusion, if the medication details which can be associated with diastolic dysfunction had been given, the study would have been more valuable.