Background: The prevalence of sarcopenia and its subtypes, such as sarcopenic obesity, osteosarcopenia, and osteosarcopenic obesity, is little known in patients with cardiovascular diseases (CVD). Methods: Physical, motor functional, and nutritional assessments were performed for 230 communitydwelling (CD) adults who came to receive a physical check-up, and 160 patients with CVD who were admitted to our hospital. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia guidelines. The subtypes of sarcopenia were consecutively diagnosed according to increased body fat percentage and decreased bone density. Results: The CVD patients had malnutrition when compared to the CD adults. Impaired motor function of the CVD patients occurred in females as compared with males. The prevalence of sarcopenia, osteosarcopenia, and osteosarcopenic obesity was higher in the CVD patients than in the CD adults (16.9% vs. 4.4%, p < 0.001; 8.8% vs. 2.6%, p = 0.009; and 4.4% vs. 0.9%, p = 0.036, respectively). The prevalence of sarcopenia in the participants positively correlated with the serum N-terminal prohormone of brain natriuretic peptide concentration. Sarcopenia in the CVD patients was present in a younger population as compared with sarcopenia in the CD adults. The prevalence odds ratio of sarcopenia in the CVD patients was higher in females (6.40, 95% CI: 2.38-17.25, p < 0.001) than males (4.03, 95% CI: 1.02-15.90, p = 0.047). Based on the data of this study, we determined a calculation formula to get an index alternative to skeletal muscle index, followed by an easy diagnosis of sarcopenia. The formula was composed of sex, weight, and calf circumference. The sensitivity and specificity for the diagnosis with the index were 80.8% and 95.6%, respectively. Conclusions: CVD may accelerate sarcopenia, osteosarcopenia, and osteosarcopenic obesity. Our calculation formula for the easy diagnosis of sarcopenia may help in an early diagnosis and prevent it before worsening the patient's prognosis.

Dual antiplatelet therapy (DAPT) with aspirin and P2Y 12 inhibitor is administered following percutaneous coronary intervention (PCI) with coronary stent implantation. Several studies have reported the effects of switching between P2Y 12 inhibitors on platelet reactivity (P2Y 12 reaction units: PRU), from acute to late phase after PCI. However, the effect of switching at very late phase is unknown. This study examined the effect on PRU in Japanese coronary heart disease patients with long-term DAPT (aspirin + clopidogrel) when switching from clopidogrel to prasugrel. Ninety-six patients were enrolled in this study. The median DAPT duration at enrollment was 1824.0 days. Twenty-three patients with PRU ≥ 208 at enrollment were randomly assigned into either continuing to receive clopidogrel (Continued Group; n = 11) or switching to prasugrel (Switched Group; n = 12). The primary endpoint was the rate of patients who achieved PRU < 208 at the end of 12 weeks of treatment, which was significantly higher in Switched Group relative to Continued Group (90.0% vs. 36.4%; P = 0.024). The secondary endpoint was the PRU at week 12 in groups subdivided according to cytochrome P450 (CYP) 2C19 genotypes. At week 12, extensive metabolizers (EM Group) had 202.3 ± 60.0 and 174.5 ± 22.3 in Continued Group and Switched Group (P = 0.591), respectively; intermediate and poor metabolizers (non-EM Group) had 229.4 ± 36.9 and 148.4 ± 48.4 in Continued Group and Switched Group (P = 0.002), respectively. The PRU for non-EM Group was significantly reduced in Switched Group. Thus, for patients with long-term DAPT (aspirin + clopidogrel) after PCI with coronary stent implantation, switching from clopidogrel to prasugrel resulted in a stable reduction in PRU, regardless of CYP2C19 polymorphism.

Keishibukuryogan is a Kampo medicine that induces vasodilation and improves the blood flow velocity in subcutaneous blood vessels. We herein report two cases in which keishibukuryogan completely diminished subcutaneous hematoma after cardiac resynchronization therapy pacemaker implantation and defibrillator battery replacement within a month. Keishibukuryogan can be a good option for treating or preventing subcutaneous hematoma after surgical procedures for devices.

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BackgroundThe lower limb muscle may play an important role in decreasing the heart’s pumping workload. Aging and inactivity cause atrophy and weakness of the muscle, leading to a loss of the heart-assisting role. An electrical lower limb muscle stimulator can prevent atrophy and weakness more effectively than conventional resistance training; however, it has been reported to increase the heart’s pumping workload in some situations. Therefore, more effective tools should be developed.MethodsWe newly developed a cardiac cycle-synchronized electrical lower limb muscle stimulator by combining a commercially available electrocardiogram monitor and belt electrode skeletal muscle electrical stimulator, making it possible to achieve strong and wide but not painful muscle contractions. Then, we tested the stimulator in 11 healthy volunteers to determine whether the special equipment enabled lower limb muscle training without harming the hemodynamics using plethysmography and a percutaneous cardiac output analyzer.ResultsIn 9 of 11 subjects, the stimulator generated diastolic augmentation waves on the dicrotic notches and end-diastolic pressure reduction waves on the plethysmogram waveforms of the brachial artery, showing analogous waveforms in the intra-aortic balloon pumping heart-assisting therapy. The heart rate, stroke volume, and cardiac output significantly increased during the stimulation. There was no change in the systolic or diastolic blood pressure during the stimulation.ConclusionCardiac cycle-synchronized electrical muscle stimulation for the lower limbs may enable muscle training without harmfully influencing the hemodynamics and with a potential to reduce the heart’s pumping workload, suggesting a promising tool for effectively treating both locomotor and cardiovascular disorders.