Impairment of Ventilatory Efficiency in Heart Failure

To the Editor: In these days of high-technology cellular biology, it is always a great pleasure to read research relating to whole-body integrated physiology. Kleber and colleagues1 are to be congratulated on presenting important data relating to the survival of real patients with exercise impairment. There are a number of important issues that I would draw attention to.The patient group does not represent the usual group of patients with chronic heart failure. They are much younger than those seen in clinical practice (51.6 years), and only 69% of them were taking diuretics.Most of the authors’ data have been presented previously.2 However, they stopped recruiting in November 1996. Given that follow-up was for a mean of 16 months and that the article was submitted in September …