beneficial effect as a class effect on HF condition. 13,14 It remains unclear, however, whether the 3 SGLT2i are similarly effective for HF itself in patients with T2DM. As a preliminary step in the observation of the long-term effectiveness of SGLT2i, it is necessary to confirm the efficacy and safety in the short term. Therefore, the goal of this study was to compare the short-term efficacy and safety of the 3 SGLT2i, canagliflozin, dapagliflozin and empagliflozin in acute decompensated HF patients with T2DM. Methods Subjects This was a single-center, non-randomized, open-label study. This study involved 81 patients who were hospitalized due to decompensated HF complicated with T2DM at Toyama University Hospital. The inclusion criteria were as follows: (1) chronic HF with guideline-directed medical therapy including angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), β-blockers and diuretics; (2) glycated hemoglobin (HbA1c) before study intervention ≥6.1% in patients with T2DM; (3) age ≥20

We recently experienced a case of cardiogenic shock due to influenza-related Takotsubo cardiomyopathy with atrial tachycardia and respiratory distress syndrome. Temporary mechanical circulatory support by IMPELLA 2.5 improved end-organ failure and resulted in cardiac recovery with sinus rhythm conversion.

The therapeutic strategy for sustained ventricular tachycardia (VT) during left ventricular assist device usage remains unclear. We encountered a patient with durable left ventricular assist device who presented sustained VT. Electrophysiological mapping was able to be established appropriately owing to the robust mechanical hemodynamics support despite inter-device interference. The three-dimensional activation map of clinically documented VT demonstrated that the propagation exited from the right ventricular apex through the critical isthmus located at the epicardium or interventricular septum, which was successfully treated by catheter ablation at the exit site. Further experiences like ours should be accumulated to establish a therapeutic strategy.

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) reduces mortality and morbidity in patients with chronic heart failure (HF). However, the clinical implication of SGLT2i therapy in patients with acute decompensated HF remains uncertain. We prospectively studied 86 type 2 diabetic mellitus (T2DM) patients (71.8 ± 12.1 years, 55 men) who were hospitalized for acute decompensated HF and received SGLT2i during the index hospitalization. Among the patients, 56 continued SGLT2i at discharge and 30 did not. The continued group experienced fewer HF re-hospitalizations than the discontinued group (24% versus 39%, P = 0.008) with a hazard ratio of 0.29 (95% confidence interval 0.10-0.85) adjusted for other significant potential confounders. In conclusion, long-term SGLT2i therapy might prevent unplanned HF re-hospitalization in patients with T2DM and acute decompensated HF.

Gastrointestinal bleeding (GIB) during mechanical circulatory support (MCS) is a major unsolved comorbidity. Inadequate activation of angiopoietin-2-related systems is considered as a major cause of GIB. However, the regulation of angiopoietin-2 remains unknown. Consecutive 20 patients who received continuous-flow MCS therapy (MCS group) and 12 with advanced heart failure (HF; HF group) were prospectively enrolled and their angiopoetin-2 levels were compared. Angiopoietin-2 level had a moderate correlation with log10 B-type natriuretic peptide (BNP; r = 0.39, p < 0.001). The MCS group had significantly higher angiopoietin-2 level divided by log10 BNP compared with the HF group (2.80 ± 0.20 vs. 1.88 ± 0.17, p < 0.001). Angiopoetin-2 had a moderate correlation with central venous pressure and C-reactive protein during the MCS support (r = 0.51 and r = 0.45, respectively). Higher angiopoietin-2 level divided by log10 BNP (> 4.3) was significantly associated with the occurrence of GIB with a hazard ratio of 296 (95% confidence interval 2.24–38620, p = 0.0224). Angiopoietin-2 was already elevated in the HF cohort and more elevated following MCS initiation. Among the MCS cohort, angiopoietin-2 was particularly elevated in patients with systemic congestion and inflammation and was associated with higher incidence of GIB.