Effect of the Sodium-Glucose Cotransporter 2 Inhibitor Canagliflozin for Heart Failure With Preserved Ejection Fraction in Patients With Type 2 Diabetes.

Background: The efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in elderly patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. Methods and Results: In a multicenter, controlled trial, the CANONICAL study, we enrolled 82 HFpEF (left ventricular ejection fraction [LVEF] ≥50%) patients with type 2 diabetes (T2D) aged ≥65 years, with plasma B-type natriuretic peptide (BNP) ≥100 pg/mL or plasma N-terminal pro BNP (NT-proBNP) ≥400 pg/mL or history of HF. Patients were randomly assigned to 2 groups and were administered either the SGLT2 inhibitor canagliflozin (100 mg/day) for 24 weeks or standard therapy. The primary endpoints were changes in body weight (BW) and BNP concentrations. Mean (±SD) patient age, body mass index, and LVEF were 75.7±6.5 years, 25.0±3.6 kg/m2 and 61.5±7.6%, respectively. At 24 weeks, BW was significantly lower in the canagliflozin than standard therapy group. The extent of BNP reductions at 4 weeks was significantly greater in the canagliflozin than standard therapy group (P<0.05), but at 24 weeks there was no significant difference between the 2 groups. Conclusions: In this study, canagliflozin treatment reduced BW, but did not significantly reduce plasma BNP concentrations compared with standard therapy after 24 weeks treatment in T2D patients with HFpEF. Further large-scale randomized studies are needed to conclude the beneficial effects of canagliflozin in T2D patients with HFpEF.

[A case of crescentic glomerulonephritis developed under oral anastrozole treatment].

A 69-year-old postmenopausal woman who was prescribed anastrozole for 10 months after surgical removal of her breast cancer, was referred to our hospital for acute renal failure. Because it was possible that her renal failure was related to her treatment with anastrozole, the treatment was immediately discontinued. After renal biopsy was performed to examine her renal failure, she was diagnosed as crescentic glomerulonephritis, probably related with the treatment of anastrozole. Twenty mg of oral prednisolone was administered daily after methylprednisolone pulse therapy(500 mg/day intravenous administration for three days). Her renal dysfunction was gradually improved. Renal dysfunction was considered to be a rare complication of anastrozole. Patients who are prescribed anastrozole should be watched carefully for the development of renal dysfunction.

Coronary plaque characteristics that indicate distal embolization during percutaneous coronary intervention in patients with stable angina-virtual histology intravascular ultrasound study.

Distal embolization (DE) is a serious complication of percutaneous coronary intervention (PCI) in patients with stable angina. The purpose of this study was to evaluate the coronary plaque characteristics that indicate DE during PCI in patients with stable angina using virtual histology intravascular ultrasound (VH-IVUS). Three hundred and sixty-four consecutive stable angina patients who underwent PCI were enrolled in this study. The patients were divided into two groups as follows: patients exhibiting DE (DE group, n = 10) and patients without DE (non-DE group, n = 354). Coronary plaque compositions were assessed by VH-IVUS. The fibro-fatty (FF) ratio (28 ± 17 vs. 11 ± 9 %, p < 0.0001) was higher in the DE group compared with the non-DE group. The best cut-off value of FF ratio for prediction of DE was 20 %, with a sensitivity of 0.80 and a specificity of 0.81 (odds ratio; 17.1, 95 % confidence interval 3.56-82.5, p = 0.0004). Coronary plaques with a high FF ratio may be the predictor of indicating DE in patients with stable angina during PCI.

Gender differences in coronary plaque characteristics in patients with stable angina: a virtual histology intravascular ultrasound study.

The purpose of this study was to compare culprit coronary plaque characteristics between female and male patients with stable angina using virtual histology intravascular ultrasound (VH-IVUS). The target population consisted of three hundred and sixty-four consecutive patients with stable angina who underwent percutaneous coronary intervention (PCI) after VH-IVUS. The baseline characteristics and VH-IVUS results were compared between 72 female and 292 male patients. Culprit coronary plaque histological composition ratios, which were classified as fibrous (FI)%, fibro-fatty (FF)%, dense-calcium (DC)% and necrotic core (NC)%, were evaluated by VH-IVUS. The HbA1c (6.4 ± 1.2% vs. 5.9 ± 1.0%, p < 0.0001), total cholesterol (202 ± 33 mg/dL vs. 189 ± 34 mg/dL, p = 0.004), and LDL-cholesterol (118 ± 32 mg/dL vs. 110 ± 27 mg/dL, p = 0.03) were higher in female patients compared to male patients. The FI ratio (55 ± 15% vs. 60 ± 15%, p = 0.02) and FF ratio (9 ± 8% vs. 12 ± 10%, p = 0.02) were lower, but the DC ratio (12 ± 13% vs. 9 ± 11%, p = 0.01) and NC ratio (23 ± 11% vs. 19 ± 12%, p = 0.02) were higher in female patients than in male patients. The differences in coronary risk factors between females and males may be associated with coronary plaque characteristics. Differences in culprit coronary plaque composition were observed between female and male patients with stable angina.