Background: The impacts of the coronavirus disease 2019 (COVID-19) pandemic on the diagnostic and therapeutic procedures for patients with coronary spastic angina (CSA) have yet to be elucidated. The present study aimed to investigate whether the COVID-19 pandemic has affected physicians' decision-making regarding the diagnosis and treatment of CSA. Subjects and Methods: Patients who underwent invasive coronary angiography and were diagnosed with CSA between January 2014 and March 2021 at the outpatient clinics of nine hospitals in Kanagawa Prefecture were enrolled in the present study. The patients were divided into two groups: pre-COVID-19 period (between January 1, 2014 and January 31, 2020) and COVID-19 period (between March 1, 2020 and March 31, 2021). We compared the patients' backgrounds and the diagnostic and therapeutic strategies between the two groups. Results: A total of 102 patients with CSA were enrolled in the present study, and there were no significant intergroup differences in patient characteristics. The implementation rate of spasm provocation tests was significantly lower in the COVID-19 than the pre-COVID-19 period group (65% vs. 90%, respectively; P = 0.004), as was the implementation rate of percutaneous coronary intervention (3% vs. 17%, respectively; P = 0.058), despite the similar prevalence of organic coronary stenosis. Conclusion: Pharmacological provocation tests were performed less frequently in patients with CSA during the COVID-19 period than during the pre-COVID-19 period.

Background・Aim: "Diabetic kidney disease" (DKD) is a collective term for all types of renal insufficiency in type 2 diabetes mellitus (T2DM). Although its introduction has facilitated diagnosis, the underlying pathophysiological mechanisms remain unclear; therefore, we recently proposed the term "metabolic syndrome nephropathy" (MetS-N). Herein, we present a new diagnostic approach for DKD/MetS-N.

Methods and Results: This retrospective analysis included 353 men with T2DM with full-house MetS (fMetS), that is, obesity, hypertension, dyslipidemia, and hyperglycemia, and were classified into the following groups: non-proteinuric without renal insufficiency, G-X (n=137), non-proteinuric with renal insufficiency, G-Y (n=169), and proteinuric with apparent kidney damage (n = 47). The current diagnostic method, which is based only on albuminuria and estimated glomerular filtration rate, was compared with a new method that combines the resistive index (RI) and renal plasma flow (RPF), which are ultrasound-determined surrogate markers of renal arteriosclerosis. The use of the new method increased the diagnosis of patients with fMetS-N from 55.2% to 95.4%, which enabled the prediction of fMetS-N progression and clarified the relationship between systemic and renal arteriosclerosis.

Conclusions: The combined use of ultrasound-determined surrogate markers of renal arteriosclerosis (RI and RPF) facilitated the diagnosis and progression of fMetS-N and its relationship with arteriosclerosis. Because of the profound influence of MetS on T2DM, analyzing RI and RPF measurements is imperative for DKD diagnosis. This new diagnostic approach may enable optimization of the management of patients with T2DM and MetS, potentially contributing to the prevention of end-stage renal failure and cerebrocardiovascular complications.

Background: Vascular calcification, especially medial calcification, is associated with an increased risk of cardiovascular events and mortality. Although some mechanisms such as oxidative stress, apoptotic cell death, and trans-differentiation of vascular smooth muscle cells to osteogenic cells have been recognized, human aortic calcification mechanisms have not been researched extensively in the past. Thus, we employed histopathological analysis of human aortic samples to elaborate the pathological findings of medial calcification.

Patients and Methods: Human aortic samples surgically resected from six patients with aortic aneurysms were immunostained. The staining intensity of each field of view was quantified according to standard scoring criteria, and the scores were compared between normal, calcified, and transitional areas of human aortic tissue sections.

Results: In normal areas of human aortic tissue sections, the elastic fibers show an orderly arrangement and elastin is highly expressed, while in calcified areas the elastic fibers are ruptured and have a disordered arrangement with markedly reduced elastin expression compared to normal and transitional areas. Significant levels of apoptotic cell death were observed in the calcified and transitional areas, although alkaline phosphatase and osteocalcin expression were not detectable.

Conclusion: Apoptotic cell death, elastin loss, and elastic fiber fragmentation may be involved in the pathogenesis of medial calcification in human aortic aneurysms.

Atherosclerosis is characterized by the response of the vessel wall to chronic multifactorial injury, which leads to the formation of atheromatous or fibrous plaques. Endothelial dysfunction is the initial stage of atherosclerosis. In addition to endothelial dysfunction, smooth muscle dysfunction and metabolic abnormalities of the vessel wall, including inflammation, oxidative stress, and alterations in the neurohormonal balance, occur in various stages of atherosclerosis. 'Vascular failure' is defined as the integration of the aforementioned vascular abnormalities. In 2018, the Physiological Diagnosis Criteria for Vascular Failure Committee of the Japan Society of Vascular Failure and the Japanese Circulation Society proposed new physiological diagnostic criteria for vascular failure using universally available diagnostic modalities. However, these physiological tests can be performed only in large hospitals or specific cardiovascular clinics due to the requirement of expensive medical equipment and skillful technicians. BNP and/or NT-proBNP have emerged as useful biomarkers for evaluating the existence and severity of congestive heart failure, even by general physicians. However, distinct specific modalities such as cardiac sonography and MRI are essential to diagnose and treat heart failure. In this context, the Japan Society of Vascular Failure organized a working group to identify and establish suitable biomarkers for detecting vascular failure. In the 8^th annual scientific meeting of the Japan Society for Vascular Failure, the working group held a symposium entitled "Possible biomarkers to detect vascular failure: What is known? What needs to be elucidated?" Herein, we elicit four presentations from the symposium and discuss them in detail.

Objectives: The central blood pressure waveform of young children is similar to that of older adults, but differs compared to that in adolescents. This study aimed to examine the accuracy of non-invasive measurements of central hemodynamics in children, adolescents, and young adults.

Methods and Results: We enrolled 23 patients with cardiac catheterization and a mean age of 10.4 ± 7.2 years (range 1.2-28.2 years, median 7.4 years) in this study. The ascending aortic blood pressure waveform was recorded using a catheter-mounted pressure sensor. Radial artery pulse-waves were recorded simultaneously and noninvasively. We analyzed the relationship between the aortic and radial augmentation indices, and between the ascending aortic systolic and central systolic blood pressure estimated by the radial second systolic pressure method. The radial augmentation index correlated significantly with the aortic augmentation index (r = 0.64, p = 0.0009). The estimated central and aortic systolic blood pressure were significantly correlated (r = 0.87, p < 0.0001). The mean difference between the estimated central systolic and aortic systolic blood pressure was 0.39 ± 7.12 mmHg. In patients with type A aortic blood pressure waveform, the radial second systolic blood pressure correlated significantly with aortic systolic blood pressure; in the case of the type C waveform, the radial first systolic blood pressure correlated strongly with aortic systolic blood pressure.

Conclusions: Central systolic blood pressure estimation by the radial second systolic pressure method is not reliable in children, adolescents, and young adults. Combining the first and second radial systolic pressure in response to the aortic pressure waveform can accurately estimate central systolic blood pressure.