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.

　背景：心血管リスクを複数有する多疾患併存状態およびその際のリスク相互の関連性に関しては十分に解明されていない．

　対象と方法：東武鉄道（株）全社員6220 名の定期健康診断結果のうち，年齢，BMI，血圧値（収縮期圧，拡張期圧），尿酸値，HbA1c 値，LDL-C 値，eGFR 値の8 項目を心血管リスクとして取り上げ，それぞれの重症度および治療の有無と各指標値間の関連性について解析した．

　結果：血圧と年齢およびBMI との間に有意の正相関がみられたほか，未治療の中等度ないし高度高血圧者のうち，腎機能が低下している群で収縮期血圧値とeGFR 値の間に有意の負の相関，HbA1c 高値群では収縮期血圧値とHbA1c 値の間に有意の正相関を認めた．また，高血圧群では正常血圧群に比して高尿酸，高HbA1c および低eGFR 状態を有する者の割合が有意に多かった．一方，尿酸およびHbA1c 単独高値群，他リスクとの組み合わせ高値群いずれも，リスクなしの正常群に比べて血圧が有意に高値，eGFR が有意に低値であった．治療の要否を基準に解析すると，血圧・HbA1c・eGFR の３者の関連性，ならびに尿酸・LDL-C・eGFR の３者の関連性が強いと考えられた．

　結論：企業の健康診断結果を分析した結果，加齢，肥満，高血圧，高尿酸，高血糖，高脂質および腎機能低下などの心血管リスクは互いにリンクしており，それぞれの治療に際しては，他の指標も考慮し総合的に治療戦略を立てることが重要であると結論された．

　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.