Acquiring direct flow based on the angiosome concept is important for limb salvage by EVT in patients with CLI.

Stent fracture worsened the patency during the first 2 years, but it did not apparently affect patency beyond 2 years. In particular, complete stent separation did not affect patency.

The origin and developmental mechanisms underlying coronary vessels are not fully elucidated. Here we show that myocardium-derived angiopoietin-1 (Ang1) is essential for coronary vein formation in the developing heart. Cardiomyocyte-specific Ang1 deletion results in defective formation of the subepicardial coronary veins, but had no significant effect on the formation of intramyocardial coronary arteries. The endothelial cells (ECs) of the sinus venosus (SV) are heterogeneous population, composed of APJ-positive and APJ-negative ECs. Among these, the APJ-negative ECs migrate from the SV into the atrial and ventricular myocardium in Ang1-dependent manner. In addition, Ang1 may positively regulate venous differentiation of the subepicardial APJ-negative ECs in the heart. Consistently, in vitro experiments show that Ang1 indeed promotes venous differentiation of the immature ECs. Collectively, our results indicate that myocardial Ang1 positively regulates coronary vein formation presumably by promoting the proliferation, migration and differentiation of immature ECs derived from the SV.

SummaryTreatment of refractory Takayasu arteritis (TA) remains an unresolved clinical issue. Patients usually respond to glucocorticoid (GC) therapy, but often relapse on tapering of the GC dose. The aim of the present study was to assess the safety and effi cacy of the interleukin-6 (IL-6) receptor antibody tocilizumab (TCZ) in patients with TA refractory to conventional therapies including GC. Four patients with TA who had shown GC resistance received TCZ infusions (8 mg/ kg) every 4 weeks a total of at least 24 times (range, 24 to 51). Clinical symptoms, the serum levels of acute phase proteins and IL-6, GC dosage necessary to maintain remission, and cross-sectional imaging by enhanced CT and MRI were assessed. All patients achieved good clinical response and rapid normalization of the acute phase proteins such as C-reactive protein and serum amyloid A during the therapy with TCZ. The mean dosage of prednisolone could be reduced from 21.3 mg/day to 1.5 mg/day. Although the serum IL-6 level was transiently elevated in all patients after several TCZ infusions, it gradually recovered to the initial level. Along with the decrease of serum IL-6, two patients exhibited significant reduction in thickened arterial lesions. No drug-related adverse effects were noted. In this small group of patients with refractory TA, TCZ therapy was effective and well-tolerated. Further larger studies should be conducted to confi rm this fi nding. (Int Heart J 2013; 54: 405-411)

AimsThe prevalence of left ventricular diastolic dysfunction increases with age, particularly in hypertensive women. We aimed to determine the age‐ and sex‐related differences in diastolic function, and its relation to alterations of cardiac dimensions in a hypertensive population.Methods and resultsWe enrolled 479 hypertensive patients with a left ventricular ejection fraction (LVEF) ≥50% (men/women, 267/212) and their echocardiographic parameters regarding LV performance and vascular function were measured. Left atrial volume index (LAVI) and operant diastolic elastance (EdI: E/e′/stroke volume index), but not LV mass index (LVMI), correlated weakly with age in both sexes. The arterial elastance index (EaI) and EdI did not differ significantly between sexes in any of the three age groups (A, <65 years; B, ≥65 years but <75 years; C, age ≥75 years). The EdI indexed to EaI, EdI/EaI = E/e′/(0.9 × systolic blood pressure), was significantly more impaired in women than in men only in group C. There were significant differences in LAVI, LVMI, and EdI/EaI between groups B and C only in women.ConclusionsImpairment of diastolic function relative to arterial elasticity, EdI/EaI, occurred in elderly hypertensive women and was coincident with the alteration of cardiac dimensions. The coincidence with the changes in diastolic function and the alterations of cardiac dimensions occurred in a different time point between the sexes.

Higher afterload-related left ventricular diastolic elastance, Ed/Ea, in association with higher arterial elastance, Ea, accompanied by left atrioventricular volume mismatch was observed in elderly HFpEF women.

Patients with persistent atrial fibrillation (AF) and a large left atrium are at a high risk for thromboembolisms. Recently, direct oral anticoagulants (DOACs) have mainly been used for the prevention of cardiac embolisms caused by AF. Transesophageal echocardiography (TEE) is performed in order to exclude any left atrial appendage (LAA) thrombi. We herein report two cases of persistent AF, both of which were treated with rivaroxaban for more than two years. Since TEE identified mobile LAA thrombi with this treatment, we switched from rivaroxaban to the direct thrombin inhibitor dabigatran. Dabigatran resolved the LAA thrombi that had been refractory to rivaroxaban.

and hemoglobin levels among 3 age groups in men (both P<0.001) and women (both P<0.001) by analysis of variance. The eGFR and hemoglobin levels decreased with age in both men (r=−0.349, P<0.001, and r=−0.469, P<0.001, respectively) and women (r=−0.418, P<0.001, and r=−0.214, P=0.002, respectively). 9 The effective arterial elastance index (EaI=[0.9×systolic blood pressure (SBP)]/stroke volume index) and operant diastolic elastance index (EdI=E/e'/ stroke volume index) did not differ significantly between the sexes. However, the EdI indexed as EaI, EdI/EaI=E/e'/ (0.9×SBP), a new marker for diastolic function assessment, was significantly more impaired in women than in men only in patients ≥75 years old (Table 2, t-test). Furthermore, in the patients ≥75 years old, the coefficient of variation in EdI/EaI was larger in women and the variations of EdI/ EaI values were significantly different between the sexes (P=0.002, F-test), although no differences were observed in patients <75 years old. There were significant differences in left atrial volume index (LAVI), LV mass index (LVMI), and EdI/EaI between patients aged ≥75 and <75 years, but only among women ( Table 2). 9 Thus, impairment of diastolic function relative to arterial elasticity, EdI/EaI, occurred in elderly women with hypertension and was coincident with alterations in cardiac structure. Importantly, the changes in 2 indices, EdI/EaI and LAVI or LVMI, coincidentally occurred at different time points between the sexes. Because Arterial Elasticity-Related Diastolic FunctionRelative to Cardiac StructureHeart failure with preserved ejection fraction (HFpEF) is an important clinical condition that mainly occurs in elderly women. 1 Two major hypotheses may explain the pathophysiology of HFpEF: increased arterial stiffness 2,3 and left ventricular (LV) passive stiffness. 4-6 The pathophysiological base of HFpEF may be an extreme form of age-related deterioration with ventricular-arterial interrelation, possibly related to the prevalence of noncardiac comorbidities. 7 Regression modeling has identified that changes in cardiac structure, such as greater LV hypertrophy (LVH) and atrial dilation, best distinguish HFpEF from hypertensive LVH without HF. 8 However, the difference between elderly men and women in diastolic function relative to arterial elasticity, and its relation to alterations in the cardiac structure of hypertensive patients, remains unclear. We therefore sought to determine the age-and sex-related differences in diastolic function relative to arterial elasticity among hypertensive patients with preserved LVEF and no history of HF. 9 We enrolled hypertensive patients with LVEF ≥50% (Table 1), and their echocardiographic parameters regarding arterial elastance and LV performance were measured. There were significant differences in estimated glomerular filtration rate (eGFR) Received November 4, 2016; accepted January 12, 2017; released online January 28, 2017 Background: The mechanisms of heart failure with preserved ejection fraction (HFpEF) need ...