BackgroundSome peripheral artery disease (PAD) patients have normal ankle brachial index (ABI) (0.9 - 1.4), although ABI is a useful parameter for the diagnosis of PAD. We investigated whether other parameters of ABI report sheet are useful to detect these patients.MethodsWe initially enrolled 3,912 patients (7,824 limbs) who underwent ABI for the first time. Subjects who have normal ABI were divided into the PAD group (n = 136) and the non-PAD group (n = 240) by lower extremity ultrasonography. We investigated blood pressures (BP) (systolic (SBP), diastolic (DBP), mean (mBP) and pulse pressure (PP)), heart rate, upstroke time (UT), and %mean arterial pressure (%MAP).ResultsSBP, mBP, PP, UT, and %MAP in the PAD group were significantly higher. A multivariate analysis showed that mBP, DBP, PP, UT and %MAP were independently associated with the presence of PAD (mBP: odds ratio (OR) 2.30, 95% confidence interval (CI) 1.22 - 4.37, P = 0.010; DBP: OR 0.52, 95% CI 0.28 - 0.97, P = 0.039; PP: OR 1.30, 95% CI 0.69 - 2.46, P = 0.041; UT: OR 3.40, 95% CI 2.03 - 5.83, P < 0.001; %MAP: OR 1.77, 95% CI 1.05 - 2.98, P = 0.031). Maximal area under the curve (AUC) of BPs for associating PAD was PP. The cut-off value of PP was 53.0 mm Hg (sensitivity 0.500, specificity 0.721, AUC 0.628, 95% CI 0.569 - 0.687).ConclusionsThe present study demonstrated that BPs are associated with PAD in patients with normal ABI. The measurement of BPs could provide additional information for the diagnosis of PAD.

BackgroundPatients with acute heart failure (HF) complicated by supraventricular tachyarrhythmia (SVT) often receive continuous intravenous infusion of landiolol or diltiazem for rate control. It is unclear whether the interval from initiation of infusion to commencement of oral beta-blocker (BB) therapy differs for these two drugs.MethodsFrom January 2013 to July 2015, 94 consecutive patients were hospitalized for acute HF complicated by SVT. After 35 patients were excluded, the remaining 59 were divided into groups treated with diltiazem or landiolol. We investigated the blood pressure, heart rate, New York Heart Association classification, brain natriuretic peptide, chest X-ray film, echocardiographic findings (ejection fraction (EF)), time until commencement of oral BB therapy, and hospital stay.ResultsThere were no significant between-group differences of heart rate, blood pressure, or the severity of HF. The time until commencing oral BB therapy was significantly shorter in the landiolol group compared with the diltiazem group (median: 2 vs. 4 days, P = 0.002), but there was no significant difference in hospital stay. This interval was significantly shorter in patients with a reduced EF in the landiolol group (median: 2 days) compared with those with a reduced EF in the diltiazem group (median: 5 days, P = 0.008), and patients with a preserved EF in the landiolol group tended to have a shorter interval (median: 2 days) than those with a preserved EF in the diltiazem group (median: 4 days, P = 0.092).ConclusionsSwitching to oral BBs was accomplished earlier with landiolol than with diltiazem.

The existence of a new cascade, angiotensin-converting enzyme (ACE) 2/angiotensin (Ang)-(1-7)/Mas receptor axis, has been recently established in the renin-angiotensin system. However, the dynamics of this cascade under various pathological conditions in clinical settings is still unclear. Forty-nine patients who underwent emergency hospitalization because of acute heart failure (AHF) consented to participate in this study. Thirty-eight healthy volunteers served as controls. Serum ACE activity, ACE2, Ang-(1-7) concentration, plasma Ang II, aldosterone concentration, and plasma renin activity (PRA) were measured at the acute stage. We conducted a comparative study between patients with AHF and healthy volunteers. Patients with AHF showed lower serum ACE activity and plasma aldosterone concentration than healthy volunteers (12.3 vs. 15.1 IU/L, respectively; P = 0.01, 75.6 vs. 125.3 pg/mL, respectively; P = 0.000); there were no differences between the two groups in PRA and plasma Ang II concentration. Patients with AHF had a higher serum ACE2 concentration than healthy volunteers (7.9 vs. 4.8 ng/mL, respectively; P = 0.002), but their serum Ang-(1-7) concentration was significantly lower (2.4 vs 3.1 ng/mL, respectively; P = 0.005). Patients with AHF had a higher serum ACE2 concentration, lower serum Ang-(1-7) concentration, and lower serum ACE activity and plasma aldosterone concentrations than healthy volunteers, whereas PRA and plasma Ang II concentration were the same.

Ipragliflozin is the first SGLT2 inhibitor approved in Japan. Reported here is a case where long-term administration of ipragliflozin decreased the rate of re-hospitalization due to heart failure (HF). An 83-year-old man with chronic HF and diabetes mellitus (DM) was hospitalized four times in the last five years. He was discharged six months after his last hospitalization, but he continued to have class III HF according to the New York Heart Association classification (NYHA), and his DM was also not properly managed. Therefore, he received ipragliflozin. One year after initiation of ipragliflozin, he lost weight (body weight (BW): 79.0 to 76.2 kg), his levels of brain natriuretic peptide (BNP) decreased (191.4 to 122.5 mg/dL), and the class of his HF improved (class III to class II). The management of DM also improved (fasting blood glucose: 100 to 110 mg/dL; hemoglobin A1C: 6.8 to 6.6%). In addition, cardiac sympathetic nerve function evaluated with I-metaiodobenzylguanidine cardiac-scintigraphy (I-MIBG) also improved (the average of the heart-to-mediastinum ratio in early and delayed phases; 1.44 to 2.17 in the early phase, 1.41 to 1.92 in the delayed phase, washout rate; 43.3 to 35.6). The patient was not re-hospitalized due to HF two years after administration of ipragliflozin started. A reduction in cardiac sympathetic nerve hyperactivity by an SGLT2 inhibitor might be one of the mechanisms of its cardio-protective effect, but clinical studies need to be conducted to verify this finding.

Background Elderly patients with heart failure (HF) have been observed to decrease activities of daily living (ADL) during hospitalization. Prevention of ADL decline from shortening of hospital stays is especially important in the elderly, because decreasing ADL is associated with poor prognosis. We investigated the relationship between the early initiation of tolvaptan (TLV) after hospitalization and the length of hospital stay in patients with HF aged younger than 80 years and aged 80 years and older. Methods We analyzed 146 patients younger than 80 years (< 80) and 101 patients aged 80 years and older (≥ 80) who were hospitalized with HF from February 2011 to June 2016 and had initiated TLV. The relationship between the time until commencement of TLV and the length of hospital stay was assessed. Additionally, a comparison made between the TLV early start group (within the median) and the delayed start group (over the median) for both groups. Multivariate analysis was also performed on factors that required hospital stays below the median. Results A significant correlation was observed between time to TLV initiation and the length of hospital stay (< 80: r = 0.382, P < 0.001; ≥ 80: r = 0.395, P < 0.001). The length of hospital stay in the early group was significantly longer than that in the delayed group for both groups (< 80: early 21.0 ± 13.0 days and 33.0 ± 22.7 days, respectively, P < 0.001; ≥ 80: early 21.3 ± 12.5 days and 32.9 ± 17.9 days, respectively, P < 0.001). Conversely, no statistically significant difference found in the length of hospital stay after initiation of TLV. Moreover, no increase in adverse events in the elderly observed. A multivariate analysis revealed that a predictive factor for short-term hospitalization was early administration of TLV regardless of age. Conclusions The early initiation of TLV after hospitalization was associated with a shorter length of hospital stay in patients with HF regardless of age.