Treatment options for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) remain limited. Selexipag, an oral selective IP prostacyclin-receptor agonist approved for pulmonary arterial hypertension, is a potential treatment option for CTEPH.In this multicentre, randomised, double-blind, placebo-controlled study, 78 Japanese patients with inoperable CTEPH or persistent/recurrent pulmonary hypertension after pulmonary endarterectomy and/or balloon pulmonary angioplasty were randomly assigned to receive placebo or selexipag. The primary endpoint was the change in pulmonary vascular resistance (PVR) from baseline to week 20. The secondary endpoints were changes in other haemodynamic parameters, 6-min walk distance (6 WMD), Borg Dyspnoea Scale score, World Health Organisation (WHO) functional class, EuroQol 5 dimensions 5-level and N-terminal pro-brain natriuretic peptide.The change in PVR was −98.2±111.3 dyn·s·cm−5 and −4.6±163.6 dyn·s·cm−5 in the selexipag and placebo groups, respectively (mean difference, −93.5 dyn·s·cm−5; 95% confidence interval, −156.8, −30.3; p=0.006). The changes in cardiac index (p<0.001) and Borg Dyspnoea Scale score (p=0.036) were also significantly improved over placebo. 6WMD and WHO functional class were not significantly improved. The common adverse events in the selexipag group were corresponded to those generally observed following a prostacyclin analogue is administered.Selexipag significantly improved PVR and other haemodynamic variables in patients with CTEPH, although exercise capacity remained unchanged. Further large-scale investigation is necessary to prove the role of selexipag in CTEPH.

FABP4 levels were significantly elevated during the early hours after the onset of AMI and were robustly increased in OHCA survivors. Together with the finding that FABP4 is released from adipocytes via β3-AR-mediated lipolysis, our data provide a novel hypothesis that serum FABP4 may represent the adrenergic overdrive that accompanies acute cardiovascular disease, including AMI.

Background: It is unclear whether adaptive servo-ventilation (ASV) is effective for all patients with heart failure (HF). The aim of the present study was therefore to investigate the effectiveness of ASV for all patients with HF. Methods and Results:Sixty-one patients with HF were recommended for ASV treatment, regardless of sleepdisordered breathing (SDB) severity and type. On the basis of the apnea - hypopnea index (AHI) results, patients were classified into 3 groups: 28 patients with AHI ≥40/h were designated as group A; 20 patients with AHI ≥20/h and <40/h were designated as group B; and 13 patients with AHI <20/h were designated as group C. After ASV treatment, brain natriuretic peptide (BNP) levels and left ventricular ejection fraction (LVEF) were improved almost equally in the 3 groups (changes in BNP level: group A, -313±480 pg/ml; group B, -401±801 pg/ml; group C, -225± 240 pg/ml; P=0.69; changes in LVEF: group A, 8.5±11.3%; group B, 10.5±9.6%; group C, 2.4±12.4%; P=0.17). Conclusions:ASV treatment for patients with mild SDB resulted in almost equal improvements in BNP levels and LVEF compared to that in patients with moderate and severe SDB, demonstrating that ASV is effective for all patients with HF. (Circ J 2011; 75: 1164 - 1169

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Recently, new vaccine platforms-including mRNA vaccines for coronavirus disease 2019 (COVID-19) have been given emergency use authorization in Japan. Here, we present a rare case of myocarditis following a COVID-19 vaccine. In this case, myocarditis was confirmed by cardiac magnetic resonance imaging, endomyocardial biopsy, and troponin levels. The degree of myocardial inflammation in the endomyocardial biopsy samples was mild and the patient's clinical course was not severe. Although the pathology of myocarditis in this case was mild, further investigation would be needed.Learning Objective: Vaccination for coronavirus disease 2019 is advancing worldwide, but post-vaccination myocarditis is getting attention as a rare side effect. Although the myocarditis in this case was mild, the pathogenesis of the disease is unclear and needs to be thoroughly investigated in the vaccination.

Deep vein thrombosis (DVT) is a common disease and is associated with pulmonary embolism (PE). Proximal iliofemoral DVT may lead to severe PE and chronic venous insufficiency. The standard therapy for DVT is anticoagulant therapy using heparin and a vitamin K antagonist, but a recent clinical study showed that rivaroxaban, an oral Xa inhibitor, was comparable to standard therapy and had less bleeding complications. Intensive high-dose anticoagulation is recommended during the initial 3 weeks of DVT treatment. The present report describes a case of a 77-year-old male showing a remarkable regression of DVT in response to rivaroxaban treatment within the initial 3 weeks of therapy and who did not experience any adverse events. His DVT was massive and was accompanied by proximal iliofemoral vein thrombus and iliac vein compression syndrome. Rivaroxaban, especially in intensive high-dose treatment, might be a safe and effective therapeutic choice for massive DVT.

Our study demonstrated that ASV therapy is safe and effective for use in very severe systolic HF patients as well as in relatively mild systolic HF patients.