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Nutrition in the cardiovascular field to date has focused on improving lifestyle-related diseases such as hypertension and diabetes from the viewpoint of secondary prevention. For these conditions, "nutrition for weight loss" is recommended, and nutritional guidance that restricts calories is provided. On the other hand, in symptomatic Stage C and D heart failure, it is known that underweight patients who manifest poor nutrition, sarcopenia, and cardiac cachexia have a poor prognosis. This is referred to as the "Obesity paradox". In order to "avoid weight loss" in patients with heart failure, a paradigm shift to nutritional management to prevent weight loss is needed. Rather than prescribing uniform recommendation for salt reduction of 6 g/day or less, awareness of the behavior change stage model is attracting attention. In this setting, the value of salt restriction will need to be determined to determine the priority level of intervention for undernutrition versus the need to prevent congestive signs and symptoms. In the Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) for acute heart failure, nutritional intervention should be considered within 48 h of admission. Key points are selection of access route, timing of intervention, and monitoring of side effects. In nutritional management at home and in end-of-life care, food is a reflection of an individual's values, as well as a source of joy and encouragement. The importance of digestive tract should also be recognized in heart failure from oral flail to intestinal edema, constipation, and the intestinal bacteria called the heart-gut axis. Finally, we would like to propose a new term "heart nutrition" for nutritional management in patients with heart failure in this review. Compared to the evidence for exercise therapy in heart failure, studies assessing nutritional management remain scarce and there is a need for research in this area in the future. [Display omitted] • In symptomatic heart failure, it is known that underweight is associated with poor prognosis and called "Obesity paradox". • In the elderly, the salt restriction may lead to loss of appetite and reduced food intake, and the degree of priority of intervention for undernutrition must be determined and salt restriction may need to be lifted to determine the moderation. • In the CCU for acute heart failure, nutritional intervention is required earlier, within 48 hours of admission, and the key points are the selection of access route, timing of intervention, and monitoring of side effects. • The importance of the digestive tract should also be recognized in heart failure from oral flail to intestinal edema, constipation, and the intestinal bacteria called the Heart-Gut axis. [ABSTRACT FROM AUTHOR]

• Circulating D-dimer levels are a biomarker for ischemic stroke prediction. • Patients with acute heart failure and nonvalvular atrial fibrillation have elevated D-dimer levels. • Edoxaban may be an effective therapy for keeping D-dimer levels at a lower level. D-dimer levels can predict ischemic stroke in patients with acute heart failure (AHF). However, the effects of direct oral anticoagulants on D-dimer levels have not been investigated during admission for AHF in patients with atrial fibrillation (AF). This study examined D-dimer levels immediately after admission and following edoxaban initiation as a sub-analysis of a multi-center study that investigated the pharmacokinetics and pharmacodynamics of edoxaban in patients with nonvalvular AF (NVAF) and AHF. Hospitalized patients with NVAF and AHF received edoxaban according to the label. The primary measure was the change in D-dimer levels on 7 consecutive days after admission for AHF. We also investigated differences according to prior edoxaban use (de novo at the time of admission or continuation). In 10/13 (76.9%) de novo patients, D-dimer levels exceeded the reference value (1.0 µg/mL) at admission (mean, 2.12 µg/mL) and subsequently decreased in 9 patients (at final blood sampling: mean, 1.12 µg/mL); 1 patient did not fall below the reference value due to stasis dermatitis. In the continuation group, most patients had D-dimer levels below the reference value from Day 1 (mean, 0.93 µg/mL), and levels remained stable or decreased (at final blood sampling: mean, 0.49 µg/mL). No events of stroke were observed. D-dimer levels may be elevated in patients with NVAF and AHF, particularly in those without prior anticoagulant treatment. Edoxaban may be effective for lowering and keeping D-dimer levels, a biomarker for predicting ischemic stroke, below the reference value in patients with NVAF and AHF. [Display omitted]. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is endemic worldwide. Cardiovascular disease, particularly myocarditis, is one of the most common comorbidities in patients with COVID-19. However, heart failure due to COVID-19-triggered cardiomyopathy is not well understood. Additionally, "pseudo" heart failure symptoms have been reported in patients with a compensated condition, in which the heart works well enough that symptoms are unnoticeable or very easy to manage. Here, we report a case of heart failure due to cardiomyopathy in a patient with COVID-19 and postural orthostatic tachycardia syndrome after heart failure treatment. Postural orthostatic tachycardia syndrome (POTS) symptoms after coronavirus disease 2019 may be mistaken for heart failure symptoms; thus, it is essential to suspect POTS when symptoms such as shortness of breath and palpitations are noted upon standing, along with the relevant physical findings. [ABSTRACT FROM AUTHOR]

Background: The number of patients with chronic heart failure is increasing in Japan. However, the annual number of patients with heart failure who receive cardiac resynchronization therapy (CRT) has been constant in the last few years. In this study, we evaluated patients who did not receive CRT despite being eligible for this treatment to elucidate the clinical impact of CRT administration. Methods: We assessed 214 patients with a left ventricular ejection fraction (LVEF) ≤ 50% (excluding patients treated with CRT) who underwent transthoracic echocardiography between January and May 2020 at our institution. The patients were stratified into two groups: Group A (n = 26; patients eligible for CRT) and Group B (n = 188; patients ineligible for CRT); however, all patients only received pharmacological therapy. We retrospectively analyzed the prognosis of these patients with respect to the cumulative number of hospitalizations for heart failure and cardiogenic deaths. Results: We observed no significant between‐group differences in age, sex, and severity/diagnosis of organic heart disease. Group A had a significantly higher number of hospitalizations for heart failure and cardiogenic deaths than Group B (log‐rank test, P <.01; hazard ratio, 3.05; 95% confidence interval, 1.31‐7.09; average follow‐up period, 675 days). Conclusions: This study shows that 12% of patients were eligible for CRT. However, the implantation rate was low and no one was implanted. CRT is underutilized in patients who have heart failure with reduced LVEF. Therefore, we strongly recommend CRT for patients with indications for CRT. [ABSTRACT FROM AUTHOR]

• Risk stratification is necessary to identify which patients need focused treatment. • Global Registry of Acute Coronary Events (GRACE) score is applicable to Japanese acute myocardial infarction patients. • A novel risk scoring system, "angiographic GRACE" could improve the performance. The Global Registry of Acute Coronary Events (GRACE) score is the most accurate risk assessment system for acute myocardial infarction (AMI), which was proposed in Western countries. However, it is unclear whether GRACE score is applicable to the present Japanese patients with a high prevalence of emergent percutaneous coronary intervention (PCI) and vasospasm. This study aimed to clarify the usefulness of GRACE risk score for risk stratification of Japanese AMI patients treated with early PCI and to evaluate a novel risk stratification system, "angiographic GRACE score," which is the GRACE risk score adjusted by the information of the culprit coronary artery and its flow at pre- and post-PCI, to improve its predicting availability. The subjects were 1817 AMI patients who underwent PCI within 24 h of onset between October 2015 and August 2017 and were registered in Kanagawa Acute Cardiovascular (K-ACTIVE) Registry via survey form. The association between the clinical parameters and in-hospital mortality was investigated. A total of 79 (4.3%) in-hospital deaths were identified. The C-statistics for the in-hospital mortality of the GRACE score was 0.86, which was higher than that of the other conventional risk factors, including age (0.65), systolic blood pressure (0.70), heart rate (0.62), Killip classification (0.77), and serum levels of creatinine (0.68) and peak creatine kinase (0.74). The angiographic GRACE score improved the C-statistics from 0.86 of the original GRACE score to 0.89 (p < 0.05). In the setting of the cut-off value at 200, in-hospital mortality in the patients with the angiographic GRACE score <200 was 0.6%, which was relatively lower than those with ≥200, 9.4%. The GRACE score is a useful predictor of in-hospital mortality among Japanese AMI patients in the PCI era. Moreover, the angiographic GRACE score could improve the predicting availability. [ABSTRACT FROM AUTHOR]

• Reference values of ventilator efficiency variables in a normal Japanese population. • Cardiopulmonary exercise testing was performed using a cycle ergometer. • Tidal volume and minute ventilation (V̇E) during ramp exercise testing were evaluated. • Slope of V̇E versus carbon dioxide (V̇E vs. V̇CO 2 slope), minimum V̇E/V̇CO 2 , and oxygen uptake efficiency slope were also determined. The current understanding of ventilator efficiency variables during ramp exercise testing in the normal Japanese population is insufficient, and the responses of tidal volume (VT) and minute ventilation (V̇E) to the ramp exercise test in the normal Japanese population are not known. A total of 529 healthy Japanese subjects aged 20–78 years underwent cardiopulmonary exercise testing using a cycle ergometer with ramp protocols. VT and V̇E at rest, at anaerobic threshold, and at peak exercise were determined. The slope of V̇E versus carbon dioxide (V̇CO 2) (V̇E vs. V̇CO 2 slope), minimum V̇E/V̇CO 2 , and oxygen uptake efficiency slope (OUES) were determined. For males and females in their 20 s, peak VT (VTpeak) was 2192 ± 376 and 1509 ± 260 mL (p < 0.001), peak V̇E (V̇Epeak) was 80.6 ± 18.7 and 57.7 ± 13.9 L/min (sex differences p < 0.001), the V̇E vs. V̇CO 2 slope was 24.4 ± 3.2 and 25.7 ± 3.2 (p = 0.035), the minimum V̇E/V̇CO 2 was 24.2 ± 2.3 and 27.0 ± 2.8 (p < 0.001), and the OUES was 2452 ± 519 and 1991 ± 315 (p < 0.001), respectively. VTpeak and V̇Epeak decreased with age and increased with weight and height. The V̇E vs. V̇CO 2 slope and minimum V̇E/V̇CO 2 increased with age, while conversely, the OUES decreased with age. We have established the normal range of VT and V̇E responses, the V̇E vs. V̇CO 2 slope, the minimum V̇E/V̇CO 2 , and the OUES for a healthy Japanese population. Some of these parameters were influenced by weight, height, sex, and age. These results provide useful reference values for interpreting the results of cardiopulmonary exercise testing in cardiac patients. [ABSTRACT FROM AUTHOR]

There is an ongoing debate regarding optimal management of patients with paradoxical low gradient severe aortic stenosis (PLG-SAS). We hypothesized that the presence of symptoms is closely associated with future adverse outcome. We aimed to determine the relation between symptoms and outcome in patients with PLG-SAS. We prospectively enrolled 222 patients with PLG-SAS. Left ventricular (LV) volumes, mass, and strain were measured by three-dimensional echocardiography. The primary end-point was cardiac events including cardiac death, ventricular fibrillation, and heart failure leading to hospitalization. There were 65 cases of symptomatic PLG-SAS and 157 cases of asymptomatic PLG-SAS. Patients with symptomatic PLG-SAS received beta-blockers, angiotensin blockers, and diuretics more frequently and showed higher levels of B-type natriuretic peptide than patients with asymptomatic PLG-SAS. Although LV chamber parameters were not different, patients with symptomatic PLG-SAS had significantly higher E-wave velocity and E/A ratio than patients with asymptomatic PLG-SAS. During the median follow-up of 18 months, 20 patients reached the primary end-point. Patients with symptomatic PLG-SAS had significantly worse prognosis than patients with asymptomatic PLG-SAS. A similar trend was observed while comparing with the propensity-score-matched cohort after adjusting for age, sex, stroke volume index, and severity of AS. Symptomatic PLG-SAS is associated with poorer prognosis even after adjusting for flow status and severity of AS. Therefore, presence of symptoms is not always related to the severity of AS itself but might be related to the underlying comorbidities. Our results suggest a possible link between PLG-SAS and heart failure with preserved ejection fraction in some symptomatic patients. [ABSTRACT FROM AUTHOR]

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This is the case of a 60-year-old male. He had no past medical history at a regular medical check-up. According to findings at the regular medical check-up, he was obese (body mass index, 32.8 kg/m 2 ), and had short neck, small jaw, and low soft palate; therefore, it was suspected that he may have sleep-disordered breathing. Blood pressure (BP) at the medical check-up was 121/80 mmHg, and the results of electrocardiogram and chest radiography were normal. Blood test data at the medical check-up indicated abnormality of lipid metabolism and hyperuricemia. No other abnormalities were found. It became clear that he became sleepy during daytime at an additional medical interview. Accordingly, he was diagnosed as having severe obstructive sleep apnea (OSA) with apnea–hypopnea index 65.3/h and arousal index 64.4/h by polysomnography. The oxygen-triggered nocturnal BP monitoring that was conducted at home around the same time indicated remarkable hypoxia-induced hypertension (Day 1: hypoxia-peak nocturnal BP 181/117 mmHg, Day 2: hypoxia-peak nocturnal BP 204/137 mmHg). The patient recognized the risk of OSA by visualizing the hypoxia-induced hypertension; therefore, introduction of continuous positive airway pressure (CPAP) therapy for severe OSA was smooth. As the results of CPAP therapy, we could confirm disappearance of hypoxia-induced hypertension. < Learning objective: An office worker without cardiovascular disease was diagnosed as having severe obstructive sleep apnea. Remarkable hypoxia-induced nocturnal hypertension was identified by oxygen-triggered blood pressure (BP) monitoring. It was considered that nocturnal hypertension, which was not able to be recorded by previous ambulatory blood pressure monitoring, was recorded by the oxygen-triggered BP monitoring method.> [ABSTRACT FROM AUTHOR]

Background We propose the use of aortic annulus displacement (AAD) detected on contrast left ventriculography (LVG) during invasive coronary angiography as a marker of left ventricular (LV) long-axis shortening. In the present study, we aimed to investigate whether AAD is associated with adverse events in patients who underwent coronary angiography because of suspected coronary artery disease. Methods In this retrospective study, we evaluated the medical records of 998 consecutive patients who underwent invasive coronary angiography and LVG. LV lengths were measured from the apex to the aortic valve insertion by using LVG images. AAD (%) was calculated as [(LV end-diastolic length − LV end-systolic length)/LV end-diastolic length] × 100. Results The participants’ median age was 67 years. Ninety-six adverse events (composite events; all-cause death, 39; congestive heart failure, 21; late revascularization, 34; and myocardial infarction, 2) were observed during a median follow-up period of 3.1 years. In multivariate Cox regression analysis, adverse events were associated with lower AAD (hazard ratio, 0.703; p = 0.002), after adjusting for traditional risk factors and coronary artery stenosis. The area under the curve of AAD for predicting adverse events was greater than that of LV ejection fraction (0.656 vs. 0.541, p < 0.05). Conclusions AAD was superior to LV ejection fraction as a predictor of adverse events in patients with and without coronary arterial stenosis. AAD may be the optimal method for assessing longitudinal LV systolic function in the catheter laboratory. [ABSTRACT FROM AUTHOR]

Background Current prognostic implication of symptomatic patients with aortic stenosis (AS) remains undetermined. This study investigated the current prognostic implications of AS-related symptoms and the effect of aortic valve replacement (AVR) on outcome. Methods We enrolled 586 consecutive patients with severe AS (aortic valve area <1.0 cm 2 ) with preserved left ventricular ejection fraction (≥50%). All patients were stratified into the following four groups based on the predominant symptoms: Group 1, asymptomatic ( n = 316); Group 2, chest pain ( n = 41); Group 3, heart failure ( n = 192); or Group 4, syncope ( n = 37). Results AS-related symptoms were diagnosed in 270 patients (46.1%), among whom 182 patients (32.2%) received AVR. Thirty-nine patients (6.7%) had cardiac death during the mean follow-up of 16 ± 14 months. AVR was associated with significant reduction in cardiac death in Groups 3 ( p < 0.001) and 4 ( p = 0.004) whereas no significant prognostic advantage of AVR was observed in Groups 1 or 2. Cox proportional-hazard multivariate analysis revealed that age, heart failure, and mean pressure gradient (PG) were associated with increased risk of cardiac death in all patients regardless of AVR [hazard ratio (HR): 1.079, 2.090, and 1.008 respectively, all p < 0.05]. In the patients without AVR, age, heart failure, syncope, and mean PG were independently associated with cardiac death (HR: 1.130, 3.639, 4.638, and 1.008, all p < 0.05). Conclusion This retrospective study demonstrated the current associations between the types of AS symptoms and prognosis in Japanese patients with severe AS. [ABSTRACT FROM AUTHOR]

Background Computed tomography is the best noninvasive imaging modality for evaluating valve leaflet calcification. Objective To evaluate the association of aortic valve leaflet calcification with instantaneous valve opening and closing using dynamic multidetector computed tomography (MDCT). Methods We retrospectively evaluated 58 consecutive patients who underwent dynamic MDCT imaging. Aortic valve calcification (AVC) was quantified using the Agatston method. The aortic valve area (AVA) tracking curves were derived by planimetry during the cardiac cycle using all 20 phases (5% reconstruction). da/dt in cm 2 /s was calculated as the rate of change of AVA during opening (positive) or closing (negative). Patients were divided into 3 three groups according to Agatston score quartile: no AVC (Q2, Score 0, n = 18), mild AVC (Q3, Score 1–2254, n = 24), and severe AVC (Q4 Score >2254, n = 14). Results In multivariable linear regression, compared to the non AVC group, the mild and severe AVC groups had lower maximum AVA (by −1.71 cm 2 and −2.25 cm 2 , respectively), lower peak positive da/dt (by −21.88 cm 2 /s and −26.65 cm 2 /s, respectively), and higher peak negative da/dt (by 13.78 cm 2 /s and 18.11 cm 2 /s, respectively) (p < 0.05 for all comparisons). Conclusions AVA and its opening and closing were influenced by leaflet calcification. The present study demonstrates the ability of dynamic MDCT imaging to assess quantitative aortic valve motion in a clinical setting. [ABSTRACT FROM AUTHOR]

Background Exercise capacity is helpful in the management of patients with mitral regurgitation (MR). However, the determinants of exercise capacity reduction in MR have remained unclear. This study was designed to objectively assess exercise capacity, identify the echocardiographic predictors of exercise capacity, and investigate its impact on development of symptoms in asymptomatic degenerative MR. Methods A total of 49 consecutive asymptomatic patients (age, 58.9 ± 13.1 years; 82% males) with at least moderate degenerative MR (effective regurgitant orifice area = 0.40 ± 0.14 cm 2 ; regurgitant volume = 60.9 ± 19.6 mL) underwent the symptom-limited cardiopulmonary exercise testing for assessing exercise capacity (peak oxygen uptake, peak V ˙ O 2 ; the minute ventilation/carbon dioxide production, V ˙ E / V ˙ CO 2 slope). All patients also underwent exercise stress echocardiography for detecting exercise-induced pulmonary hypertension (EIPH) defined by systolic pulmonary arterial pressure (SPAP) ≥60 mmHg. Results The mean peak V ˙ O 2 was 22.6 ± 5.1 mL/kg/min (86.7 ± 14.1% of age, gender-predicted); peak V ˙ O 2 widely varied (48–121% of predicted), and was markedly reduced (<80.4% of predicted) in 24% of the study patients. The patients with EIPH had lower 2-year symptom-free survival than those without EIPH ( p = 0.003). The multivariable analysis demonstrated that EIPH was an independent echocardiographic determinant of peak V ˙ O 2 ( p = 0.001) and V ˙ E / V ˙ CO 2 slope ( p = 0.021). Furthermore, the area under curve of age- and gender-adjusted exercise SPAP was 0.88 (95% confidence interval: 0.78–0.97) for reduced exercise capacity. Conclusions In asymptomatic moderate to severe degenerative MR, EIPH was independently associated with exercise capacity and predicted the occurrence of symptoms. Exercise stress echocardiography is an important tool in managing patients with asymptomatic degenerative MR. [ABSTRACT FROM AUTHOR]

Background Whether the prognosis of paradoxical low-gradient severe aortic stenosis (PLG-SAS), especially due to paradoxical low-flow low-gradient SAS (PLFLG-SAS), is malignant in any specific ethnicity, including Japanese, remains unclear. Methods We retrospectively enrolled 385 consecutive Japanese patients (age, 76 ± 8 years; 148 men) with moderate AS [MAS: 0.6 ≤ indexed aortic valve area (iAVA) < 0.85 cm 2 /m 2 ] or SAS (iAVA <0.6 cm 2 /m 2 ) with preserved left ventricular ejection fraction (≥50%). SAS patients were divided into PLG-SAS and high-gradient (HG)-SAS according to the transvalvular mean gradient (40 mmHg). PLG-SAS was categorized into 2 groups: normal-flow (NF) LG-SAS [stroke volume index (SVi) ≥35 mL/m 2 ] and PLFLG-SAS (SVi <35 mL/m 2 ). Endpoints were all-cause death and major adverse cardio-cerebrovascular events (MACE). Results During a median follow-up of 15 months, 31 patients died and 48 suffered MACE. All-cause death and MACE rates in PLG-SAS and PLFLG-SAS were significantly lower than those in HG-SAS and similar to those in MAS. On multivariate analysis, neither PLG-SAS nor PLFLG-SAS were independent determinants for all-cause death compared with MAS [MAS as reference, PLG-SAS: hazard ratio (HR) 0.47, p = 0.32; PLFLG-SAS: HR 0.01, p = 0.20; HG-SAS: HR 3.37, 95% confidence interval 1.24–9.74, p = 0.02]. Conclusions In Japanese patients, the prognoses of PLG-SAS and PLFLG-SAS were better than that of HG-SAS and similar to that of MAS, being better than that in Western populations. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to determine which strain component assessed by 2-dimensional speckle-tracking echocardiography (2DSTE) and 3-dimensional speckle-tracking echocardiography (3DSTE) was the most powerful predictor for future major adverse cardiac events (MACE) in asymptomatic patients with severe aortic stenosis (AS). Background Ongoing debate exists regarding the appropriateness of early surgery in asymptomatic severe AS and preserved left ventricular ejection fraction (LVEF). Previous studies showed that 2-dimensional global longitudinal strain (2DGLS) was a significant predictor in asymptomatic severe AS patients. However, the prognostic utility of 3DSTE-derived multidirectional strain parameters has not been investigated in these patients. Methods We enrolled 104 asymptomatic severe AS patients (indexed aortic valve area <0.6 cm 2 /m 2 ) and preserved LVEF and performed strain analysis using both 2DSTE and 3DSTE. Two-dimensional and 3-dimensional global longitudinal, circumferential, and radial strain and global 3-dimensional strain were measured in each patient. All patients were followed to record MACE. Results During a median follow-up of 373 days, MACE developed in 33 patients (32%). 2DGLS (−14.7 ± 3.3 vs. −16.3 ± 3.3, p = 0.0168), 3DGLS (−13.5 ± 2.5 vs. −16.1 ± 2.4, p < 0.0001) and 3-dimensional global radial strain (3DGRS) (35.9 ± 4.5 vs. 38.1 ± 4.4, p = 0.0209) were significantly impaired in patients with MACE compared with those without MACE. Kaplan-Meier analysis showed 2DGLS (cutoff: −17.0%), 3DGLS (cutoff: −14.5%), and 3DGRS (cutoff: 39.0%) provide a significant difference in MACE rate. Receiver-operating characteristic analysis revealed that the area under the curve of 3DGLS for MACE (0.78) was significantly larger than that of 2DGLS (0.62, p = 0.0044) and 3DGRS (0.66, p = 0.0069). Separate multivariate analysis revealed 3DGLS was only significant as independent predictor for future MACE after correcting for mean pressure gradient and left ventricular mass index. Conclusions 3DGLS is the most robust index for predicting future adverse cardiac events in asymptomatic severe AS patients with preserved LVEF. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) is characterized as a metabolic disorder syndrome that is upstream of hypertension, dyslipidemia, and diabetes mellitus (DM). This study investigated exercise training effects on the exercise tolerance and heart rate dynamics in patients with IR or pancreatic β-cell dysfunction. Methods: Seventy patients (mean age, 60.1 years) with myocardial infarction (MI) participating in a phase II cardiac rehabilitation program were studied. Patients diagnosed with DM were excluded. Homeostasis model-assessment indices were used to divide patients into three groups - A: IR; B: normal; and C: β-cell dysfunction. A cardiopulmonary exercise test (CPX) was performed and peakoxygen uptake (V02) was measured. After baseline testing, subjects participated in a supervised, combined aerobic and resistance exercise program. Results: Peak V02 at baseline was comparable among the three groups, and it improved after training in all groups (p < 0.05). However, both the increase and percentage increase in peak V02 were smaller in Group C than in Group A (p < 0.05). Heart rate (HR) reserve (peak HR-rest HR), and HR recovery immediately 1 min after exercise during CPX were calculated in 45 patients who were not taking negative chronotropic agents. Group C alone did not show any significant increase in HR reserve. HR reserve at both baseline and after training had significant positive correlations with peak V02. HR recovery was 1.9 beats/min lower in group C than group A, but this was not significant. HR recovery in group C did not increase after cardiac rehabilitation. Conclusion: Impaired HR reserve increase after training in patients with pancreatic β-cell dysfunction attenuates exercise training effects on functional capacity. Comprehensive treatment including vigorous exercise training will be needed in such prediabetic patients. [ABSTRACT FROM AUTHOR]

Background: Early detection of pulmonary arterial hypertension (PAH) is indispensable, although, echocardiography at rest alone does not provide sufficient evidence for it. Here, this study aimed to investigate the usefulness of simple exercise echocardiography using a Master's two-step test for detecting early PAH. Methods: This study included 52 connective tissue disease patients who had mild symptoms in World Health Organization functional classification 2, suspected as having early PAH, and underwent exercise echocardiography and right heart catheterization. Echocardiography was performed before and after the Master's two-step exercise test; the study patients were classified into the non-PAH (mean pulmonary arterial pressure<25mmHg, n = 37) or PAH (mean pulmonary arterial pressure≥25mmHg, n = 15) groups. Results: Rest systolic pulmonary artery pressure estimated using echocardiography did not significantly differ between the two groups; however, a significant difference in post-exercise systolic pulmonary artery pressure was found (non-PAH, 58.8 ± 10.8mmHg; PAH, 80.2 ± 14.3mmHg, p<0.0001). The multiple logistic regression analysis indicated post-exercise systolic pulmonary artery pressure as an independent predictor of PAH (p = 0.013). The area under the curve by post-exercise systolic pulmonary artery pressure was 0.91 for PAH. Post-exercise systolic pulmonary artery pressure ≥ 69.6mmHg predicted PAH with the sensitivity of 93% and the specificity of 90%. Conclusions: Simple exercise echocardiography using the Master's two-step test could detect PAH in mildly symptomatic connective tissue disease patients. The usefulness of this method should be verified for the early detection of PAH. [ABSTRACT FROM AUTHOR]

Background: Speckle tracking echocardiography (STE)-derived mitral annular displacement (MAD) utilizes the speckle tracking technique to measure strain vectors, which provides accurate estimates of left ventricular ejection fraction (LVEF). Here, we investigated a link between STE-derived MAD and LVEF in patients with different heart diseases and evaluated its clinical usefulness. Methods: This study included 266 outpatients and 84 controls. Of the study patients, 52 patients had ischemic heart disease (IHD), 37 patients had dilated cardiomyopathy (DCM), 34 patients had hypertrophic cardiomyopathy (HCM), 74 patients had valvular heart disease (VHD), and 69 patients had hypertensive heart disease (HHD). STE continuously tracked annular motion throughout the cardiac cycle in the apical 4- and 2-chamber views. Results: In all participants, the curvilinear relationship was found between STE-derived MAD and LVEF (R² = 0.642). The strong correlation between STE-derived MAD and LVEF was also found in the patients with IHD (R² = 0.733, p = 0.001 ) and in those with DCM (R² = 0.614, p = 0.008). However, such a correlation was not found in the patients with HCM, VHD, or HHD. Conclusion: The specificity in the correlation between STE-derived MAD and LVEF was found in patients with each heart disease, which should be taken into account when assessing these parameters. [ABSTRACT FROM AUTHOR]

Summary: Background and purpose: Ambulatory blood pressure monitoring (ABPM) provides an accurate assessment of blood pressure (BP) and shows non-dipper BP pattern in many sleep apnea syndrome (SAS) patients with hypertension (HTN); however, little information is available on the relationship between the severity of SAS and circadian BP changes in SAS patients without HTN. This study investigated whether SAS patients without HTN would have different BP courses in the severity of SAS. Methods and subjects: Seventy-four consecutive outpatients without HTN [systolic BP (BPs) at clinic <140mmHg and/or diastolic BP (BPd) at clinic <90mmHg], who received no antihypertensives, underwent overnight polysomnography (PSG) and ABPM. The apnea–hypopnea index (AHI) was calculated from the PSG results; patients were stratified into the following 4 groups based on their AHI: non-SAS, mild-, moderate-, or severe-SAS. Results: The diurnal BPs and BPd showed no differences in the severity of SAS; however, the sleep BPs, lowest BPs, and pre-awake BPs were significantly higher in the severe-SAS group than the non-SAS group (p =0.02, p =0.04, and p =0.006, respectively). The sleep BPd and pre-awake BPd were significantly higher in the severe-SAS than the non-SAS (p =0.01 and p =0.0003, respectively) and mild-SAS (p =0.01 and p =0.008, respectively) groups. Conclusions: The results of this study suggested that SAS affected nocturnal BP elevation even in SAS patients without HTN. The diurnal BP showed no difference in the severity of SAS; however, the severe-SAS group revealed significant nocturnal BP elevation. [Copyright &y& Elsevier]

Summary: Background: Nowadays, early detection and treatment can often keep chronic kidney disease patients from getting worse and prevent the occurrence of cardiovascular disease. Cystatin C (Cys-C) is a new marker for renal dysfunction. This study investigated whether Cys-C played an important role for screening coronary artery disease. Methods: The consecutive 88 outpatients (51 males and 37 females), who were suspected of having effort angina pectoris or asymptomatic ischemic heart disease, were enrolled. Serum Cys-C, which was obtained within 3 months before coronary angiography, was assessed with the presence or absence of coronary arteriosclerosis, the number of culprit arteries, and blood biochemical parameters. Results: Mean serum Cys-C was 0.82±0.29mg/l. Significant differences in the estimated creatinine clearance (p =0.036), hemoglobin A1c (p =0.01), left ventricular ejection fraction (p =0.01), creatinine (p =0.007), Cys-C (p =0.006), and high-density lipoprotein (HDL) cholesterol (p =0.001) were observed between the patients with or without coronary arteriosclerosis. Serum Cys-C was significantly greater in the multi-vessel disease (MVD) group than the 0 vessel disease (0VD) group (p <0.001). HDL cholesterol was significantly lower in the MVD group than the 0VD and single-vessel disease groups (p =0.002 and p =0.005, respectively). Conclusion: The results of this study suggest Cys-C might be one of the risk factors for coronary arteriosclerosis in the patients with suspected ischemic heart disease without any history of coronary artery disease. Cys-C was a useful marker to detect coronary artery disease and the level of Cys-C could reflect the severity of coronary arteriosclerosis. [Copyright &y& Elsevier]

Summary: Background: Recently, sleep disordered breathing (SDB) has gained attention in the field of cardiology. Until now, no study describing the relationship between acute coronary syndrome (ACS) and SDB has been carried out in Japan. Methods: Among ACS patients admitted to our hospital, 44 patients (mean age 60.6±13.5 years) who received a portable polysomnography to measure apnea hypopnea index (AHI) were selected for this study. The circadian pattern of ACS onset was studied in 6-h intervals. In addition, all subjects were divided into three groups according to AHI severity (AHI<5, 5≤AHI<15, and 15≤AHI). Then, a comparative study between peak time of ACS and AHI severity was conducted for each group. Results: In the AHI<5 group, 66.0% patients suffered from ACS between 12:00h and 18:00h and 17.0% between 18:00h and 24:00h, and a total of 83.0% patients had ACS between 12:00h and 24:00h. In the 5≤AHI<15 group, 49.9% patients had ACS between 24:00h and 06:00h, 16.7% patients between 06:00h and 12:00h. 12:00–18:00h and 18:00–24:00h showed no significant difference. All 22 patients in the 15≤AHI group suffered from ACS between 24:00h and 12:00h. Conclusion: The results of this study suggest a possible relationship between SDB and the onset of ACS between midnight to morning. [Copyright &y& Elsevier]

We tested the hypothesis that female and male mice differ in terms of cardiac hypertrophy after deoxycorticosterone acetate (DOCA)+salt hypertension (uninephrectomy and 1% saline in drinking water) and focused on calcineurin signaling. We excluded confounding effects of blood pressure elevation or sex-related blood pressure differences by treating DOCA-salt mice with hydralazine (250 mg/L in drinking water). We found that directly measured mean arterial blood pressure was lowered to control values with hydralazine and corroborated this finding in separate mouse groups with radiotelemetry. Male mice were more responsive to DOCA-salt-related effects. They developed more left ventricular hypertrophy and more renal hypertrophy after 6 weeks of DOCA-salt+hydralazine compared with female mice. In hearts, transcripts for calcineurin Abeta and for myocyte-enriched calcineurin interacting protein 1 were upregulated in male but not in female mice. Enhanced activity of calcineurin Abeta, as indicated by diminished phosphorylation of NFATc2 in male mice, accounted for this sex-specific difference. Stretch-related, inflammatory, and profibrotic responses were also accentuated in male mice, as shown by higher transcript levels of atrial natriuretic peptide, monocyte chemoattractant protein-1, and transforming growth factor-beta. Our results support sex-specific regulation of the calcineurin pathway in response to largely blood pressure-independent mineralocorticoid action. We suggest that sex-specific calcineurin activation determines the maladaptive cardiac and renal hypertrophic responses and accompanying organ injury in male mice. [ABSTRACT FROM AUTHOR]