Background: Although activities of daily living (ADL) are recognized as being pertinent in averting relevant readmission of heart failure (HF) and mortality, little research has been conducted to assess a correlation between a decline in ADL and outcomes in HF patients. Methods: The Kitakawachi Clinical Background and Outcome of Heart Failure Registry is a prospective, multicenter, community-based cohort of HF patients. We categorized the patients into four types of ADL: independent outdoor walking, independent indoor walking, indoor walking with assistance, and abasia. We defined a decline in ADL (decline ADL) as downgrade of ADL and others (non-decline ADL) as preservation of ADL before discharge compared with admission. Results: Among 1253 registered patients, 923 were eligible, comprising 98 (10.6%) with decline ADL and 825 (89.4%) with non-decline ADL. Decline ADL exhibited a higher risk of hospitalization for HF and mortality compared with non-decline ADL. A multivariate analysis revealed that decline ADL emerged as an independent risk factor of hospitalization for HF [hazard ratio (HR), 1.42; 95% confidence interval (CI): 1.01-1.96; p = 0.046] and mortality (HR, 1.95; 95% CI: 1.23-2.99; p < 0.01). Although 66.3% of patients with decline ADL were registered for long-term care insurance, few received daycare services (32.7%) or home-visit medical services (8.2%). Conclusions: Decline in ADL is a predictor of hospitalization for HF and mortality in HF patients.

Although the prognosis of multivessel spasm is believed to be poor, this may not necessarily be so. Anginal attacks due to sequential and simultaneous multivessel spasm seem to be more dangerous than those involving single-vessel spasm or migratory multivessel spasm.

A sixty-two-year-old man who underwent coronary angiography and received acute thrombolytic and anticoagulant therapy for acute myocardial infarction developed multisystemic injury, including renal insufficiency and cutaneous manifestations. Fundoscopic examination and skin biopsy specimen led to the diagnosis of multiple cholesterol embolization syndrome (MCES). Discontinuation of anticoagulants and administration of hemostatic (carbazochrome, tranexamic acid, reptilase, and vitamin K) and antihyperlipidemic (cholestyramine and probucol) drugs resulted in temporary improvement of cutaneous and renal disorders and extended survival for about one year. Besides severe aortic atherosclerosis, postmortem examination revealed numerous cholesterol emboli to multiple organs. MCES is a rare but serious complication of left heart catheterization and anticoagulant therapy, and the optimal treatment remains to be established. The authors suggest here that the above-mentioned therapy might be effective for management of MCES.

anagement of patients with drug-refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM) is a challenging problem. Septal myotomy/myectomy and mitral valve replacement have been performed for 3 decades, but these surgical treatments carry significant mortality, and the postoperative prognoses are not always favorable. Anticoagulation must be continued permanently after mitral valve replacement, and symptomatic deterioration and aortic regurgitation have been reported in patients after myotomy/myectomy. [1][2][3] Recently, atrioventricular (AV) sequential pacing with a short AV delay has been proposed as a therapeutic method for patients with drug-refractory HOCM, 4 and some investigators have reported favorable results from therapeutic dual-chamber (DDD) pacemaker implantation. 5-7 However, the guidelines for the indication of pacemaker implantation in these patients have not been established yet. The purpose of the present study was to evaluate whether the chronic effects of DDD pacing with a short AV delay can be predicted from the temporary AV sequential pacing in

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