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(Circulation. 2000;101:e74.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Selenium and Chronic Heart Failure

Michel de Lorgeril, MD; Patricia Salen, BSc

Laboratoire du Stress Cardiovasculaire et, Pathologies Associées, Université de Grenoble, Grenoble, France

	Introduction

 
To the Editor:

We read with interest the article by Inoko et al about selenium deficiency,¹ but we do not agree with the interpretation of the data.

Selenium deficiency was identified as a factor in the etiology of heart failure syndromes in areas of very low selenium intakes, such as China, where an endemic selenium-responsive cardiomyopathy is called Keshan disease.² Similar cases of cardiomyopathy were reported in HIV-infected patients³ and in subjects on parenteral nutrition.⁴ The patient with Crohn’s disease described by Inoko et al falls into the latter category. When the patient developed his first episode of heart failure, the serum selenium level was not very low (62 µg/L). Low selenium was unlikely the single cause of heart failure, although it certainly contributed. Supplementation "improved the condition of the patient but did not normalize the left ventricular dysfunction," and "despite selenium supplementation for 11 years, the echocardiographic findings gradually deteriorated."¹ The patient "was free from symptoms of heart failure for 11 years" and died suddenly.¹

This discrepancy between the symptoms of heart failure and left ventricular dysfunction emphasizes that the pathophysiology underlying the symptoms of chronic heart failure is complex and poorly understood.⁵ There is no single cause of the main symptoms of heart failure (dyspnea and muscle fatigue), and treatments that correct the hemodynamics of heart failure do not reliably increase exercise tolerance or reduce the severity of dyspnea.⁵

The case described by Inoko et al suggests that selenium may have a role in the symptoms of heart . . . [Full Text of this Article]

Moriaki Inoko, MD; Takashi Konishi, MD; Satoru Matsusue, MD; Yoichiro Kobashi, MD

Department of Cardiology, Abdominal Surgery, and Pathology, Tenri Hospital, Tenri, Japan