BackgroundGlycosuria produced by sodium–glucose co-transporter-2 (SGLT-2) inhibitors is associated with weight loss. SGLT-2 inhibitors reportedly might reduce the occurrence of cardiovascular events. Epicardial adipose tissue (EAT) is a pathogenic fat depot that may be associated with coronary atherosclerosis. The present study evaluated the relationship between an SGLT-2 inhibitor (dapagliflozin) and EAT volume.MethodsIn 40 diabetes mellitus patients with coronary artery disease (10 women and 30 men; mean age of all 40 patients was 67.2 ± 5.4 years), EAT volume was compared prospectively between the dapagliflozin treatment group (DG; n = 20) and conventional treatment group (CTG; n = 20) during a 6-month period. EAT was defined as any pixel that had computed tomography attenuation of − 150 to − 30 Hounsfield units within the pericardial sac. Metabolic parameters, including HbA1c, tumor necrotic factor-α (TNF-α), and plasminogen activator inhibitor-1 (PAI-1) levels, were measured at both baseline and 6-months thereafter.ResultsThere were no significant differences at baseline of EAT volume and HbA1c, PAI-1, and TNF-α levels between the two treatment groups. After a 6-month follow-up, the change in HbA1c levels in the DG decreased significantly from 7.2 to 6.8%, while body weight decreased significantly in the DG compared with the CTG (− 2.9 ± 3.4 vs. 0.2 ± 2.4 kg, p = 0.01). At the 6-month follow-up, serum PAI-1 levels tended to decline in the DG. In addition, the change in the TNF-α level in the DG was significantly greater than that in the CTG (− 0.5 ± 0.7 vs. 0.03 ± 0.3 pg/ml, p = 0.03). Furthermore, EAT volume significantly decreased in the DG at the 6-month follow-up compared with the CTG (− 16.4 ± 8.3 vs. 4.7 ± 8.8 cm3, p = 0.01). Not only the changes in the EAT volume and body weight, but also those in the EAT volume and TNF-α level, showed significantly positive correlation.ConclusionTreatment with dapagliflozin might improve systemic metabolic parameters and decrease the EAT volume in diabetes mellitus patients, possibly contributing to risk reduction in cardiovascular events.

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We found reductions in heart rate and cardiac conduction and loss-of-function mutations in SCN5A in patients with idiopathic ventricular fibrillation associated with early repolarization. These findings support the hypothesis that decreased sodium current enhances ventricular fibrillation susceptibility.

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We appreciated hearing from Casado-Arroyo et al regarding our recently published article, "Electrocardiographic Characteristics and SCN5A Mutations in Idiopathic Ventricular Fibrillation Associated With Early Repolarization," showing that SCN5A is a novel causative gene of early repolarization syndrome. 1 In this study, we identified 3 SCN5A mutations in 3 unrelated patients with idiopathic ventricular fibrillation associated with early repolarization (or early repolarization syndrome). Because all of the patients had J-point elevation in the right precordial lead(s) in addition to J-point elevation in the inferior/lateral leads, Casado-Arroyo et al suggested that all of our patients have Brugada syndrome based on their recent findings that the risk of arrhythmia events is similar between patients with the Type 1 Brugada electrocardiographic pattern in 1 of the right precordial leads and patients with the Type 1 electrocardiographic pattern in Ͼ1 lead. 2 However, we respectfully disagree because our patients never met the diagnostic criteria for Brugada syndrome. 3 The diagnosis of Brugada syndrome is made when patients have a Type 1 Brugada electrocardiographic pattern, which is characterized by a prominent coved STsegment elevation displaying a J-wave amplitude or ST-segment elevation Ն0.2 mV followed by a negative T-wave in Ն2 of the right precordial leads in the absence or presence of sodium channel blockers. 3 Although the J-point elevation was Ն0.2 mV in 1 (Patients 2 and 3) or 2 (Patient 1) of the right precordial leads in our patients, there was no clear negative T-wave such that these patients did not exhibit a Type 1 electrocardiogram. The results of a sodium channel blocker challenge are positive in almost all patients with Brugada syndrome as shown by studies performed by our group and by the Brugada group, 4,5 but the results were negative for all of our patients. Although Patient 3 had an R367H SCN5A mutation, which has been identified in another family affected by Brugada syndrome, 6 the penetrance is incomplete in Brugada syndrome and identical mutations in SCN5A can result in different phenotypes, indicating the importance of genetic modifiers and environmental influences in determining disease susceptibility. 7,8 Furthermore, the same mutation in KCNJ8 has recently been identified in patients with Brugada syndrome and in those with early repolarization syndrome, further supporting the hypothesis. 9 The letter by Casado-Arroyo et al presents important recent issues: the similarities and differences in both the genetic backgrounds and clinical characteristics between early repolarization syndrome and Brugada syndrome. Mutations in SCN5A have been identified in up to 30% of patients with Brugada syndrome, 3 and we identified SCN5A as 1 of the causative genes of early repolarization syndrome. 1 Furthermore, mutations in the cardiac L-type Ca 2ϩ channel genes and those in KCNJ8 have been linked to both diseases. 9 -11 Because early repolarization syndrome and Brugada syndrome share genetic backgroun...

The VF storms in the IVF patients were highly associated with J waves that showed augmentation prior to the VF onset. Isoproterenol was effective in controlling VF and attenuated the J waves, which diminished to below the diagnostic level during follow-up. VF recurred in patients followed up without antiarrhythmic agents.

A 7-year-old boy who presented with a painful left hemiscrotal mass was diagnosed with acquired lymphangioma of the scrotum. Chronic friction from a cast for Perthes' disease might have been the cause of sudden enlargement of a congenital lymphangioma of the scrotum. Magnetic resonance imaging (MRI) was useful for preoperative diagnosis and determining the extent of the scrotal lesions. Total excision of the mass leaving the overlying skin was successfully performed. The clinical significance of MRI for preoperative diagnosis and planning surgical resection of this lesion is discussed.