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This study aimed to investigate the relationship between nondipper pulse rate (PR) and hypertensive target organ damage. Ambulatory blood pressure monitoring was conducted in 940 high‐risk Japanese patients enrolled in the Japan Morning Surge Home Blood Pressure Study. Nondipper PR was defined as (awake PR−sleep PR)/awake PR <0.1. The authors measured the patients' brain natriuretic peptide (BNP) and left ventricular mass index (LVMI). The nondipper PR group (n=213) had a significantly higher prevalence of high BNP (≥35 pg/mL, 39.9% vs 26.1%; P<.001) than the dipper PR group (n=727). LVMI was significantly higher in the nondipper PR patients compared with the dipper PR patients among the women (mean LVMI: 111.3±32.4 vs 104.2±26.7 g/m2, P=.03) but not the men (mean LVMI: 117.6±32.0 vs 117.2±33.1 g/m2, P=.92). In conclusion, the nondipper PR was associated with cardiac overload.

SummaryA 45-year-old hypertensive Japanese woman presented with epigastric pain on inspiration, fever, complete atrioventricular block and polyarthritis. Her antistreptolysin O levels were markedly elevated. A diagnosis of rheumatic fever was made according to the modified Jones criteria. She was prescribed loxoprofen sodium, which was partially effective for her extracardiac clinical symptoms. However, she had syncope due to complete atrioventricular block with asystole longer than 10 seconds. Consequently, we implanted a permanent pacemaker. Although we prescribed prednisolone, the efficacy of which was limited for the patient's conduction disturbance, the complete atrioventricular block persisted. In our systematic review of 12 similar cases, the duration of complete heart block was always transient and there was no case requiring a permanent pacemaker. We thus encountered a very rare case of adult-onset acute rheumatic fever with persistent complete atrioventricular block necessitating permanent pacemaker implantation. (Int Heart J 2015; 56: 664-667) Key words: Carditis, ASO, Complete atrioventricular block A cute rheumatic fever is an autoimmune disorder following post-suppurative streptococcal pharyngitis, which leads variably to arthritis, chorea, dermal manifestations, and most importantly, carditis. Acute rheumatic fever usually occurs in children between the ages of 5 and 15 years. In Japan and other developed countries, the incidence of acute rheumatic fever has fallen to very low levels due to improved hygienic standards and the routine use of antibiotics for acute pharyngitis. In fact, in Japan, according to a patient survey by the Ministry of Health, Labour and Welfare, it has been too rare a disease to count the total number of patients since 2005.Cases of adult-onset acute rheumatic fever with complete atrioventricular block have been reported in developed countries, though very rarely. It has been reported that patients with adult-onset acute rheumatic fever sometimes develop complete atrioventricular block due to excessive vagal tonus activation. 1)Therefore, most researchers have reported that the dysfunction of the atrioventricular node caused by adult-onset acute rheumatic fever might be transient or reversible.2-7) Against this background, we experienced a very rare case of a patient diagnosed with adult-onset acute rheumatic fever with complete atrioventricular block requiring implantation of a permanent pacemaker. We report the details of this case and discuss the relevant earlier case reports. Case ReportFive days before admission, a 45-year-old Japanese woman who had been receiving antihypertensive therapy (doxazosin 1 mg/day) for 3 years presented with epigastric pain on inspiration. She was admitted to another hospital due to fever with temperatures above 38°C and complete atrioventricular block (65 beats/minute). Neither she nor her family members had any history of upper respiratory tract infection. There was no other history of cardiorespiratory complaints. There was no familial...

Background The optimum timing of revascularization strategy for stenoses in nonculprit vessels in patients with ST‐segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains unclear. At present, there is no evidence investigating the outcome of staged percutaneous coronary intervention (PCI) within two weeks from admission among STEMI patients with MVD. Methods A total of 210 STEMI patients with MVD who underwent primary PCI were analyzed. We compared the all‐cause mortality and major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, heart failure, unstable angina, and stroke) with median follow‐up of 1200 days among the patients who underwent staged PCI within two weeks from admission (staged PCI ≤2 W) (n = 75), staged PCI after two weeks from admission (staged PCI >2 W) (n = 37) and culprit‐only PCI (n = 98) in patients with STEMI and MVD. Results The staged PCI ≤2 W showed lower all‐cause mortality than culprit‐only PCI (4.0 vs 29.6%, log‐rank P = 0.001), and lower incidence of MACE than the staged PCI >2 W group (1.3 vs 18.9%, log‐rank P = 0.001) and culprit‐only PCI group (1.3 vs 22.5%, log‐rank P = 0.001). In the multivariable Cox regression analysis, the staged PCI ≤2 W was a predictor of lower all‐cause mortality (hazard ratio [HR], 0.176; 95% confidence interval [CI], 0.049‐0.630; P = 0.008) and lower incidence of MACE (HR, 0.068; 95% CI, 0.009‐0.533; P = 0.011), but staged PCI >2 W was not. Conclusion In conclusion, staged PCI within two weeks after admission showed more favorable outcomes compared with staged PCI after two weeks from admission or culprit‐only PCI in STEMI patients with MVD.

Increased heart rate (HR) is associated with cardiovascular events (CVE) not only in the general population and individuals with cardiovascular risk factors, 1-6 but also in patients with coronary artery disease (CAD). 7,8In patients with heart failure (HF), it is well established that low HR is associated with significantly lower rates of CVE. 9 Current evidence strongly supports the use of β-blockers (BBs) in HF patients with reduced left ventricular ejection fraction (HFrEF). Although it is known that higher doses of BBs are associated with significantly lower rates of CVE, 9-11 a low dose of β-blocker is also effective if