We would like to thank Whalley et al. (1) for their letter in this issue of Diabetes Care and for their interest in our work (2). For the most part, the results they describe are in agreement with the conclusions of our article. However, the authors report a higher incidence of diastolic dysfunction, perhaps because their subjects constituted a higher risk group with poorly controlled type 2 diabetes. Interestingly, the group with a pseudonormal pattern of diastolic dysfunction was younger than the group with an abnormal diastolic function (on average, 4 years younger than our group).
These results further emphasize the importance of using preload reducing maneuvers, such as the Valsalva maneuver, to unmask left ventricular diastolic dysfunction in type 2 diabetic subjects. Clearly, erroneous conclusions about cardiac function may be drawn if such maneuvers are not used. This must be a consideration in the design of prospective future studies dealing with type 2 diabetic subjects. Finally, in our experience, the Valsalva maneuver is much easier, more rapid, and more sensitive than the use of glyceryl trinitrate, particularly when patients remain in the supine position.
Address correspondence to Paul Poirier, MD, FRCPC, FACC, Quebec Heart Institute/Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada, G1V 4G5. E-mail: firstname.lastname@example.org.