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Aims To examine the effects of a 24-month treatment with ipragliflozin on carotid intima-media thickness (IMT) in type 2 diabetes patients. Methods and results In this multicenter, prospective, randomized, open-label, and blinded-endpoint investigator-initiated clinical trial, adults with type 2 diabetes and haemoglobin A1C (HbA1c) of 6.0–10.0% (42–86 mmol/mol) were randomized equally to ipragliflozin (50 mg daily) and non-sodium-glucose cotransporter-2 (SGLT2) inhibitor use of standard-care (control group) for type 2 diabetes and were followed-up to 24 months. The primary endpoint was the change in mean common carotid artery IMT (CCA-IMT) from baseline to 24 months. A total of 482 patients were equally allocated to the ipragliflozin (N = 241) and control (N = 241) groups, and 464 patients (median age 68 years, female 31.7%, median type 2 diabetes duration 8 years, median HbA1c 7.3%) were included in the analyses. For the primary endpoint, the changes in the mean CCA-IMT from baseline to 24 months were 0.0013 [95% confidence interval (CI), −0.0155–0.0182] mm and 0.0015 (95% CI, −0.0155–0.0184) mm in the ipragliflozin and control groups, respectively, with an estimated group difference (ipragliflozin-control) of −0.0001 mm (95% CI, −0.0191–0.0189; P = 0.989). A group difference in HbA1c change at 24 months was also non-significant between the treatment groups [−0.1% (95% CI, −0.2–0.1); P = 0.359]. Conclusion Twenty-four months of ipragliflozin treatment did not affect carotid IMT status in patients with type 2 diabetes recruited in the PROTECT study, relative to the non-SGLT2 inhibitor-use standard care for type 2 diabetes.

Cardiac involvement has been reported in patients with coronavirus disease 2019 (COVID-19). We herein report a 41-year-old man who presented with recurrent paroxysmal atrioventricular block without showing significant cardiac injuries or comorbidities. The patient was diagnosed with COVID-19 and admitted to our hospital, where he was noted to have paroxysmal atrioventricular block. Cardiac biomarkers, echocardiography, and cardiac magnetic resonance imaging findings were fairly normal. An endomyocardial biopsy performed before the implantation of a permanent pacemaker revealed mild myocardial fibrosis without inflammatory infiltrates. The unusual myocardial involvement of the novel coronavirus was suspected.

The aim of this study was to evaluate the association of functional mitral regurgitation (FMR), preserved or reduced ejection fraction (EF), and ischemic or nonischemic origin with outcomes in patients discharged alive after hospitalization for acute decompensated heart failure (HF). Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 3,357 patients were evaluated to assess the association of FMR, preserved or reduced EF, and ischemic or nonischemic origin with the primary end point (all-cause death and readmission for HF after discharge). At the time of discharge, FMR was assessed semiquantitatively (classified as none, mild, or moderate to severe) by color Doppler analysis of the regurgitant jet area. According to multivariable analysis, in the ischemic group, either mild or moderate to severe FMR in patients with a preserved EF had a significantly higher risk of the primary end point than patients without FMR (hazard ratio [HR] 1.60; 95% confidence interval [CI] 1.12 to 2.29; p = 0.010 and HR 1.98; 95% CI 1.30 to 3.01; p = 0.001, respectively). In patients with reduced EF with an ischemic origin, only moderate to severe FMR was associated with a significantly higher risk of the primary end point (HR 1.67; 95% CI 1.11 to 2.50; p = 0.014). In the nonischemic group, there was no significant association between FMR and the primary end point in patients with either a preserved or reduced EF. In conclusion, among patients with acute decompensated HF with a preserved or reduced EF, the association of FMR with adverse outcomes may differ between patients who had an ischemic or nonischemic origin of HF.

A low ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) has been reported to correlate with coronary heart disease (1–3), and no previous studies have investigated serum polyunsaturated fatty acid (PUFA) levels exclusively in patients with diabetes, in whom atherosclerotic diseases are commonly found. We therefore examined the association between serum EPA/AA ratio and the prevalence of diabetic angiopathies in patients with type 2 diabetes. The serum levels of EPA and AA were determined in 744 Japanese patients with type 2 diabetes (aged 67 ± 12 years, 60% males, duration of diabetes 13 ± 11 years, estimated glomerular filtration rate [eGFR] 78 ± 32 mL/min/1.73 m2, serum EPA 79.6 ± 52.6 μg/mL, serum AA 189.5 ± 55.0 μg/mL) and in 285 age- and sex-matched subjects without diabetes between October and December 2012. …

Background: Three-dimensional rotational angiography or atriography (3DATG) is useful for AF ablation. However the suitable timing of contrast injection into the right atrium is unknown. Therefore, we investigated the usefulness of the time from the injection to the left ventricle filled with contrast medium (TLV) to predict the timing of contrast delivery for the 3DATG. Method: From August 2010 to March 2011, we measured the TLV in 48 patients with arrhythmia. For the measurement of TLV, a pigtail catheter was introduced into right atrium and 20 milliliters of contrast medium was injected in one second for the test injection. Result: The average of TLV was 9.2±2.4 sec (range 4.5–17.3 sec). Stepwise multiple regression analysis revealed that gender, BNP level, left ventricular ejection fraction (LVEF) and LA dimension remained significantly associated with TLV (r=0.519, 0.657, 0.698, 0.730 respectively, p

Background: Multidetector computed tomography (MDCT) visualization of the pulmonary veins (PV) and left atrium provides the necessary anatomic information for successful left atrial ablation and PV isolation. However, the potential risks due to exposure to ionizing radiation associated with MDCT have raised concerns. Objectives: The purpose of this study was to compare radiation exposure between prospective and retrospective ECG-gated CT angiography (hereafter, prospective CTA, retrospective CTA). Methods: The 64-slice MDCT (Discovery CT 750HD, GE Healthcare) was performed 78 consecutive patients. Twenty-eight patients were analyzed by prospective CTA using step-and-shoot protocol, and 50 patients were analyzed by retrospective CTA. Results: Mean (±SD) effective radiation exposure in the prospective CTA group was 2.2±0.8 mSv compared to 15.4±5.9 mSv in the retrospective CTA group (p

Objectives: To explore the potential of a novel 64-multidetector row computed tomography (64-MDCT) program (SynchroGRAF), work in progress) for the evaluation of left ventricular mechanical dyssynchrony (LVMD). Methods: Twelve patients with depressed LV and wide QRS (P group: LVEF=31.0±7.8%, QRS=160.9±19.1 ms) and fifteen controls (N group: LVEF=68.8±7.0%, QRS=89.0±7.5 ms) were assessed with respect to LVMD using a 64-MDCT program. The program is capable of time-thickness analysis and can visualize regional LV wall thickening timing during a cardiac cycle. To evaluate LVMD, we used systolic dyssynchrony index (SDI) that was defined as standard deviation of time to maximal wall thickening of 17 LV segments×100/RR. Results: SDI of P group was significantly greater than that of N group (14.6±4.7 vs. 3.9±1.4, p=0.0001). The case of a 80 year old male with non-ischemic cardiomyopathy with a QRS duration 188 ms, underwent cardiac resynchronization therapy (CRT) and showed clinical improvement with marked LV reverse remodeling. In whom SynchroGRAF successfully demonstrated baseline LV dyssynchrony and resynchronization achieved by CRT asevidenced by a significant decrease in SDI (21.2 to 7.5). Conclusion: This preliminary finding implies the potential utility of the program for LVMD evaluation. Quantitative assessment of dyssynchrony may be possible using this novel method, but further evaluation of the methodology is required.

BackgroundCoronary perforation (CP) is a rare, sometimes lethal complication of percutaneous coronary intervention (PCI).ObjectivesThe purpose of this study was to review the cases of CP and to investigate the management after CP.MethodsA total of 3469 PCIs were performed in our institution from April 1999 to April 2008. All CP cases were identified from our computerized database.ResultsThirty patients were identified as having CP (0.86%). According to the Ellis classification, we determined the grade of perforation as type I in 17 cases (56%), type II in 2 cases (7%), and type III in 11 cases (37%). Most CPs were caused by wires (53%), while balloons, stents, and atherectomy devices were responsible for 7%, 37%, and 3%, respectively. Wire caused only 1 case of type III CP (6%), while stent caused 9 type III CPs (82%, p