Abstract
Kim DB et al. Clin Cardiol. 2013;36:358–362.
To the Editor:
We read with great interest the article by Kim and colleagues titled “Improvement of Arterial Stiffness in the Transition From Acute Decompensated Heart Failure to Chronic Compensated Heart Failure,” which was recently published in Clinical Cardiology.1
The authors investigated the changes in pulse wave velocity (PWV) as patients transition from acute decompensated heart failure (ADHF) to chronic compensated heart failure (CCHF). They concluded that central and upper‐extremity PWVs are increased in ADHF and improve as patients transition from ADHF to CCHF. This study gives detailed and valuable information and highlights the changes in PWVs as a marker of arterial stiffness related to the development of heart failure. Some comments may be of interest.
Different glucose indices, such as insulin level and insulin resistance, can be used to evaluate the disturbances of glucose metabolism in heart failure patients. Insulin resistance is one of the major risk factors for the development of cardiac dysfunction and heart failure. In addition to impaired endothelial function, the major cause of insulin resistance can be explained by overactivity of the sympathetic system in ADHF patients and eurohormonal overactivity in CCHF patients. In patients with insulin resistance, reduced exercise tolerance and coronary flow reserve as an indicator of microvascular dysfunction can be observed. High insulin level and insulin resistance can inhibit endothelial functions, which may stiffen the arterial wall.2, 3, 4 In addition, due to direct vascular effects of alcohol and caffeine, changes in arterial stiffness and vascular flow reserve can be observed.5
If assessment of alcohol/caffeine habits and drug treatments (glitazones, moxonidine) with positive effects on insulin sensitivity were provided, as well as an evaluation of insulin resistance, the study could have more valuable and explain the conflicting findings.
Emre Yalcinkaya, MD Murat Celik, MD Salim Yasar, MD Department of Cardiology Gulhane Military Medical Faculty Ankara, Turkey Baris Bugan, MD Department of Cardiology Malatya Army Hospital Malatya, Turkey
References
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