Background: Waon therapy improves heart failure (HF) symptoms, but further evidence in patients with advanced HF remains uncertain. Methods and Results:In 19 institutes, we prospectively enrolled hospitalized patients with advanced HF, who had plasma levels of B-type natriuretic peptide (BNP) >500 pg/ml on admission and BNP >300 pg/ml regardless of more than 1 week of medical therapy. Enrolled patients were randomized into Waon therapy or control groups. Waon therapy was performed once daily for 10 days with a far infrared-ray dry sauna maintained at 60°C for 15 min, followed by bed rest for 30 min covered with a blanket. The primary endpoint was the ratio of BNP before and after treatment. In total, 76 Waon therapy and 73 control patients (mean age 66 years, men 61%, mean plasma BNP 777 pg/ml) were studied. The groups differed only in body mass index and the frequency of diabetes. The plasma BNP, NYHA classification, 6-min walk distance (6MWD), and cardiothoracic ratio significantly improved only in the Waon therapy group. Improvements in NYHA classification, 6MWD, and cardiothoracic ratio were significant in the Waon therapy group, although the change in plasma BNP did not reach statistical significance. No serious adverse events were observed in either group. Conclusions:Waon therapy, a holistic soothing warmth therapy, showed clinical advantages in safety and efficacy among patients with advanced HF. (Circ J 2016; 80: 827 -834)

Background The ablation index (AI) is reported to be useful for a durable pulmonary vein isolation (PVI). However, there have been no studies investigating the relationship between the power, contact force (CF), AI, and steam pops. Methods Using an in vitro model, ablation energy was delivered until a steam pop occurred and the time to the steam pop and AI when the steam pop occurred were measured. The experiment was performed with a combination of various powers (20, 30, 40, and 50 W) and contact forces (CFs) (10, 30, and 50 g) 20 times for each setting. The analysis consisted of two protocols. The first protocol was a comparison between the ablation power and several parameters under the same CF (10, 30, and 50 g). The second protocol was a comparison between the CF and several parameters under the same power (20, 30, 40, and 50 W). The correlation between the lesion formation and ablation parameters was evaluated. Results The AI value when steam pops occurred varied depending on the ablation settings. All AI median values were <500 under an ablation power of 50 W. On other hand, the median ablation time up to the steam pop was more than 46 seconds, but all median values of the AI were more than 550 under an ablation with 20 W. Conclusions The AI cannot predict steam pops. A low power and long duration ablation could obtain a high AI value. However, high‐power ablation could not obtain a high AI value because of an early occurrence of steam pops.

Introduction: The influence of power (Watt [W]) and total energy (Joule [J]) on lesion size and the optimal overlap ratio remain unclear in laser balloon (LB) ablation for atrial fibrillation. We aimed to evaluate lesion size and visible gaps after LB ablation with various energy settings and different overlap ratios in vitro model. Methods and Results:Chicken muscles were cauterized using the first-generation LB with single applications of full and a half duration of six energy settings (5.5 W/30 seconds [165 J] to 12 W/20 seconds [240 J]) and varying power (5.5-12 W) at the constant total energy (160 J). Three overlapped ablations with different ratios (25% and 50%) for each energy setting were also performed to evaluate the visible gap degree categorized from 1 (perfect) to 3 (poor). Twenty lesions were evaluated for each energy setting. In single applications of full duration, lesion depth, lesion volume, and maximum lesion diameter increased according to the total energy (all, P < .001) and were greater than in those of half duration in each energy setting (all, P < .05).However, applications with larger power created larger lesion volume and maximum lesion diameter at constant total energy (P < .05). The visible gap degree was better in all energy settings with 50% overlapped ablation than in those with 25% (all, P < .001).Conclusion: Lesion size depends not only on power but also on total energy in the LB ablation. Sufficiently overlapped ablations allow continuous lesion formation. K E Y W O R D S laser ablation experiment, laser balloon, laser energy setting, lesion size, optimal overlap ratio

Aims The blood urea nitrogen (BUN)/creatinine ratio is a strong prognostic indicator in patients with acute decompensated heart failure (ADHF). However, the clinical impact of a high BUN/creatinine ratio at discharge with respect to renal dysfunction, neurohormonal hyperactivity, and different responsiveness to decongestion therapy remains unclear. Herein, we examined (i) the predictive value of a high BUN/creatinine ratio at discharge and (ii) its haemoconcentration-dependent effects, in patients with ADHF. Methods and resultsThe West Tokyo Heart Failure registry was a multicentre, prospective cohort registry-based study that enrolled patients hospitalized with a diagnosis of ADHF. The endpoint was post-discharge all-cause death. Based on the degree of haemoconcentration, patients (n = 2090) were divided into four subcategories. In multivariate proportional hazard analyses, a higher BUN/creatinine ratio was independently associated with higher all-cause mortality in the total population and in the extreme haemodilution (ΔHaemoglobin ≤ À0.9 g/dL) and haemoconcentration (0.8 g/dL ≤ ΔHaemoglobin) subcategories, but not in the modest haemodilution/haemoconcentration subcategories. Conclusions A higher BUN/creatinine ratio at discharge was independently associated with higher post-discharge all-cause mortality in patients with ADHF. The predictive value of a high BUN/creatinine ratio at discharge was haemoconcentration dependent and may be an unfavourable predictor in patients showing excessive haemoconcentration and haemodilution, but not in those showing modest haemoconcentration/haemodilution.

Coronary angiographic and risk factor (RF) characteristics were analyzed in 133 Japanese patients with ischemic heart disease (IHD) who were less than 40 years old and who had undergone coronary angiography (CAG) during the past 10 years at six university hospitals in the Tokyo area. We compared the coronary angiographic characteristics of the subject group with those of 216 controls with coronary sclerosis detected by CAG who were more than 40 years old (older control group) and the RF characteristics with those of 133 sex- and age-matched volunteers (younger control group). Sixty seven percent of the subjects (89 cases) were diagnosed as having myocardial infarction (MI) and 33% (44 cases) had angina pectoris (AP). Coronary artery disorders in this group consisted of 103 (77%) cases of coronary sclerosis, 20 (15%) cases of coronary spasm and 10 (8%) cases of miscellaneous diseases, eg, possible vasculitis with connective tissue disease, congenital anomalies, etc. The incidences of significant (> or = 75%) sclerotic narrowing in 0 vessels (31%) and 1 vessel (49%) in the subject group were significantly (p < 0.01) higher than those in the older control group, while the incidence of multivessel disease was significantly (p < 0.05) less in the subject group than in the older control group. The incidences of the following coronary risk factors were significantly (p < 0.05) higher in the subjects than in the younger controls: smoking (83% vs 35%), hypercholesteremia (44% vs 10%), obesity (31% vs 9%), hypertension (29% vs 3%), familial IHD (28% vs 7%) and diabetes mellitus (19% vs 2%). Thus, zero- or single-vessel disease predominated in the younger subject group and the prevalence of coronary risk factors was significantly higher in the subject.