To elucidate involvement of age-related impairments of right ventricular (RV) distensibility in the elderly congestive heart failure (CHF), we examined the prevalence of less-distensible right ventricle in patients with preserved left ventricular ejection fraction (LVEF) over a wide range of ages. In 893 patients aged from 40 to 102 years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave. Using signal-processing techniques, the prominent 'Y' descent of jugular pulse waveform was detected as a hemodynamic sign of a less-distensible right ventricle. Prevalence of less-distensible right ventricle and elevated RV systolic pressure increased along with aging from the 50s to the 90s in an exponential fashion from 3.3 and 12% up to 33 and 61%, respectively (p < 0.001 for each). This age-dependent deterioration of ventricular distensibility was not observed for the left ventricle. Higher age and higher RV systolic pressure were independently associated with less-distensible right ventricle (Odds ratio, 1.05 per 1 year, p = 0.003; and 1.03 per 1 mmHg, p = 0.026, respectively). The elderly CHF was associated with high prevalence of the less-distensible right ventricle and higher RV systolic pressure, both of which were independent risk factors for CHF (Odds ratio, 5.27, p = 0.001, and 1.08 per 1 mmHg, p < 0.001, respectively). In elderly patients with preserved LVEF, the combination of a less-distensible right ventricle and a high RV systolic pressure seems to be related to developing CHF. The less-distensible right ventricle and elevated RV systolic pressure are closely associated with CHF with preserved LVEF in the elderly patients.

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp by sleep apnea in addition to cardiac unloading by positive pressure. 14 Short-term CPAP (end-expiratory pressure [EEP] 10 cmH2O) in patients with HF modestly increases or does not change muscle sympathetic nerve activity (MSNA), which comprises vasoconstrictor impulses into vascular smooth muscle to regulate systemic blood pressure. 7,15 By contrast, our preliminary study showed that short-term ASV (EEP 5 cmH2O + variable pressure support from 3 to 10 cmH2O) reduced MSNA in patients with HF and periodic breathing (PB). 16 A higher level of CPAP (10 cmH2O) compared with ASV should suppress cardiac performance more in patients with HF who have less congestion, 17 and result in an increase in MSNA. However, it remains unknown whether the effect of ASV on MSNA differs from that of CPAP at comparable pressure levels; whether suppressing PB is important to the sympathoinhibitory effect of these devices in patients with HF also remains unknown.Therefore, the present randomized controlled study examined the hypothesis that ASV would improve respiratory instability more effectively and exert a greater sympathoinhibitory effect than CPAP.reathing abnormalities are very frequently associated with chronic heart failure (HF) and their presence is an indicator of poor prognosis. 1-5 Recent clinical studies have closely related breathing abnormalities to sympathetic overactivation in patients with HF. 6-8 Attenuated sympathetic outflow entrainment mediated by pulmonary mechanoreceptors is considered to be a potent mechanism of sympathetic overactivation in these patients. 9 Editorial p 1323Adaptive servoventilation (ASV) is a novel method of providing positive expiratory airway pressure and of adding varying pressure support (servoventilation function). 10 Ventilation is servo-controlled with a high-gain integral controller to maintain minute ventilation. So far, long-term ASV has conferred the benefit of increased cardiac function determined by ejection fraction (EF) or brain natriuretic peptide (BNP) levels compared with continuous positive airway pressure (CPAP) alone. 11-13 This advantage of ASV might be attributable to more effective alleviation of hypoxia and sympathetic overactivation induced Background: Long-term adaptive servoventilation (ASV) increases cardiac function more effectively than continuous positive airway pressure (CPAP), possibly via alleviation of sympathetic overactivation. The present study evaluated the effect of ASV and CPAP at comparable pressure on muscle sympathetic nerve activity (MSNA) in patients with heart failure (HF) and with or without periodic breathing (PB).

Background: The accuracy of the remote dielectric sensing (ReDSTM) system, which is a noninvasive electromagnetic-based technology to quantify lung fluid levels, particularly among those with small body size, remains uncertain. Methods: Hospitalized patients with and without heart failure underwent assessment of lung fluid levels with ReDS and successive chest computed tomography imaging. We performed a correlation analysis of the ReDS measurement, representing lung fluid levels, and computed tomography-derived high attenuation area percentage, which also provides a spatial quantification of lung fluid level. Results: A total of 46 patients (median 76 years old, 28 men), including 28 patients with heart failure, were included. The median ReDS value was 28% (interquartile: 23%, 33%), and the median percentage of high attenuation area was 21.6% (14.4%, 28.5%). ReDS values and percentage of high attenuation area were moderately correlated (r = 0.65, p < 0.001), irrespective of the existence of heart failure. ReDS value independently predicted the percentage of high attenuation area seen on computed tomography (p < 0.001). Conclusions: The ReDS system may be a promising, noninvasive tool to quantify fluid lung levels, as validated by comparison with chest computed tomography imaging. Further studies are warranted to validate the utility and applicability of this technology to a variety of clinical scenarios.

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