Heart failure (HF) is a chronic and progressive functional deterioration as a final common pathway of organic cardiac disorders. Its prevalence has been increasing worldwide, and to cope with this pandemic, various medical therapeutics including medical therapy has been developed. We herein review recently introduced four drugs for the treatment of HF (Sodium-glucose transporter 2 inhibitors, ivabradine, esaxerenone, and Angiotensin receptor-neprilysin inhibitor), especially focusing on the evidences from the population study and the presumed mechanisms involved.

　Background: The correlations remain to be determined in patients with multiple cardiovascular (CV) risk factors.

　Objectives and Methods: A total of 6220 office workers who had received routine medical checkups were enrolled. Correlations among age, BMI, blood pressure (BP), uric acid (UA), HbA1c, LDL-C, and eGFR were determined in relation to their severity and treatment needed.

　Results: Blood pressure showed significant positive correlations with age and BMI. A significant negative correlation was observed between systolic BP and eGFR in an untreated hypertension group with impaired renal function; a positive correlation was also found between systolic BP and HbA1c in a group with elevated HbA1c. Elevated UA, elevated HbA1c and depressed eGFR were more frequent in a hypertensive group than in a normotensive group. Blood pressure in an elevated UA, elevated HbA1c, and comorbid group was significantly higher than that in a no risk group. This suggests that the correlations among BP, HbA1c, and eGFR and among UA, LDL-C, and eGFR are relevant in terms of treatment needed.

　Conclusion: The results showed correlations among CV risk factors, including aging, obesity, hypertension, hyperglycemia, dyslipidemia, and renal dysfunction. This indicates that a comprehensive approach is essential in developing the treatment strategy for patients with multiple CV risk factors.

　Background/Objectives: There were no available data about pathophysiology of refractory functional dyspepsia (FD). We have reported that refractory FD patients and, especially refractory epigastric pain syndrome (EPS) patients highly involve FD patients concomitant with pancreatic enzyme abnormalities. We tried to clarify whether clinical characteristics and pathophysiology in EPS alone patients were associated with pancreatic enzyme abnormalities.

　Methods: We classified 112 FD patients into 21 EPS symptom alone, 28 PDS symptom alone, and 63 EPS-PDS overlapped patients who were initially presenting with anti-acid therapy-resistant FD symptoms. Clinical symptoms, anxiety and depressive state were estimated by GSRS, STAI and SRQ-D. Gastric emptying was evaluated. Five kinds of pancreatic enzyme such as amylase, lipase, trypsin, PLA2 and elastase-1 were measured.

　Results: SRQ-D score, STAI-state and STAI-trait scores of EPS alone patients were significantly (p ＝ 0.02, p ＝ 0.03 and p ＝ 0.01, respectively) higher than those of PDS alone patients. PCS and MCS of EPS alone patients were significantly lower than those of PDS alone patients (p ＝ 0.04, p ＝ 0.006). There were no significant differences in Tmax and T1/2 values between EPS alone patients and PDS alone patients. AUC5 and AUC15 values were significantly (p＝0.003 and p ＝ 0.005, respectively) disturbed in EPS alone patients compared to PDS alone patients. There were no significant differences in amylase, lipase, elastase-1, trypsin and PLA2 between EPS alone patients and PDS alone patients.

　Conclusions: Although there were not significant differences in five kinds of pancreatic enzyme levels between EPS alone patients and PDS alone patients, measuring of early phase of gastric emptying may be a useful tool for the diagnosis of distinct two groups.

　Background: It is known that there is diurnal variation of noise in the measurement of ventricular late potentials (LPs) by high-resolution Holter electrocardiogram (ECG), but the frequency components of the noise have not been sufficiently evaluated.

　Objectives: This study aimed to analyze the high-frequency signal intensity of the noise region in ECG signals, evaluate its effect on LP measurements, investigate the cause of the noise, and examine the optimal measurement conditions.

　Methods: ECG signals obtained from three XYZ-axis leads were subjected to time-frequency analysis, and the high-frequency signal intensities for each lead at 40 Hz, 80 Hz, 120 Hz, 160 Hz, and 200 Hz were compared and examined in the time series.

　Results: No sharp increase or significant attenuation in high-frequency signal intensity was observed with the increase in frequency. The high-frequency signal intensity increased during daytime activity and decreased during nighttime sleep.

　Conclusion: The capture of electromyogram signals of respiratory and postural maintenance muscles was thought to be responsible for increased high-frequency noise in high-resolution Holter ECG recordings. Since the high-frequency noise was reduced during nighttime sleep, this timing was considered to be suitable for LP measurements.