The Aldosterone Receptor Blockade in Diastolic Heart Failure (Aldo-DHF) study1 tested the hypothesis that aldosterone inhibition with spironolactone would result in improvement in maximum exercise capacity (peak V̇o2) or diastolic function (E/e′), each a co-primary end point. Whereas resting E/e′ was reduced by spironolactone, exercise capacity was not. The method of patient selection may have contributed to a false-negative result. We believe that this study illustrates the fundamental problems with the current concept of heart failure (HF) with preserved ejection fraction (EF) and, in particular, the role of exercise in this syndrome.
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