Demographic Trends and Changes in the Pre- and In-Hospital Medical Management of Acute Myocardial Infarction During the First 12 Months of the COVID-19 Pandemic in Mie Prefecture　- Report From the Mie ACS Registry.

Background: Even though hospital admissions for acute myocardial infarction (AMI) decreased globally during the COVID-19 pandemic in early 2020, limited information is available on subsequent demographic trends in the number of cases and management of AMI through the first 12 months of the COVID-19 pandemic. Methods and Results: We assessed demographic trends, patient characteristics, and AMI outcomes (n=730) during the first 12 months of the COVID-19 pandemic and compared them with corresponding months during the control period (February 2016-January 2020; n=2,742) using data from the Mie ACS Registry. Although a 25.8% reduction in hospitalizations for AMI was observed in the 3 months following the declaration of a state of emergency (47.7 vs. 64.3/month; P=0.002), the total number of AMI patients was similar between the 12-month COVID-19 and control periods (60.8 vs. 57.2/month; P=0.58). The number of patients requiring direct ambulance transport was lower in the first half of the COVID-19 than control period (44.4% vs. 51.5; P=0.028). In-hospital mortality was higher in the second half of the COVID-19 than control period (8.9% vs. 5.8%; P=0.032). Conclusions: Through the first 12 months of the COVID-19 pandemic, the number of AMI cases was similar to that in previous years. The COVID-19 pandemic changed the behavior of AMI patients and both pre- and in-hospital medical management, which significantly affected the severity and prognosis of AMI.

Untangling the obesity paradox in patients with acute myocardial infarction after primary percutaneous coronary intervention (detail analysis by age).

BACKGROUND: Obesity is associated with increased morbidity and mortality. However, obesity paradox has been discussed in some patients with cardiovascular disease. OBJECTIVES: We investigated the mechanisms of the obesity paradox in acute myocardial infarction (AMI) patients. METHODS: We evaluated 1634 AMI patients with primary percutaneous coronary intervention (PCI). Patients were divided into 6 subgroups according to baseline body mass index (BMI) (low BMI: <20 kg/m2, normal BMI: 20-24.9 kg/m2, high BMI: ≥25 kg/m2) and age (the younger and elderly groups consisting of patients <70 and ≥70 years old). The primary outcome was defined as all-cause mortality. RESULTS: During the follow-up periods (median, 620 days; range, 344 to 730 days), 8.7% of patients experienced all-cause death. According to the Kaplan-Meier survival analysis, the patients in the younger age group with high BMI demonstrated significantly higher all-cause mortality compared to the other patients in the same age group (P = 0.012). In contrast, patients in the elderly age group with low BMI demonstrated significantly higher all-cause mortality compared to the others in the same age group (P < 0.001). Multivariate cox regression analyses showed that low BMI in the elderly age group (HR 1.69, 95% CI 1.12 to 2.55, P = 0.012) and high BMI in the younger age group (HR 2.77, 95% CI 1.19 to 6.45, P = 0.018) were independent predictors of all-cause mortality. CONCLUSIONS: The obesity paradox was recognized only in patients in the elderly age group and not in the younger age group. The prognostic impact of BMI may differ by age in AMI patients.

Long term trends in atmospheric concentrations of polycyclic aromatic hydrocarbons and nitropolycyclic aromatic hydrocarbons: A study of Japanese cities from 1997 to 2014.

Total suspended particulate matter (TSP) was collected during the summer and winter in five Japanese cities spanning Hokkaido to Kyushu (Sapporo, Kanazawa, Tokyo, Sagamihara and Kitakyushu) from 1997 to 2014. Nine polycyclic aromatic hydrocarbons (PAHs) with four to six rings, including pyrene (Pyr) and benzo[a]pyrene (BaP), were identified using high-performance liquid chromatography (HPLC) with fluorescence detection. Two nitropolycyclic aromatic hydrocarbons (NPAHs), 1-nitropyrene (1-NP) and 6-nitrobenzo[a]pyrene (6-NBaP), were identified by HPLC with chemiluminescence detection. A comparison of PAH and NPAH concentrations and [NPAH]/[PAH] ratios such as [1-NP]/[Pyr] and [6-NBaP]/[BaP] revealed the following characteristics in the five cities: (1) In Sapporo, Kanazawa, Tokyo and Sagamihara, the concentrations of PAHs and NPAHs were high at the beginning of the sampling period and then steadily decreased, with NPAHs decreasing faster than PAHs. The large initial [1-NP]/[Pyr] ratios suggest that the major contributor was automobiles but subsequent decreases in this ratio suggest decreased automobile contributions. (2) By contrast, PAH concentrations in Kitakyushu did not decrease during the sampling period, though concentrations of NPAHs decreased. The consistently smaller [1-NP]/[Pyr] ratio and larger [6-NBaP]/[BaP] ratio in Kitakyushu suggests that the major contributor of PAHs was not automobiles but iron manufacturing which uses a large amount of coal. The sudden increase in atmospheric PAH concentrations in the winter of 2014 may also be due to iron manufacturing.

Echocardiographic Assessment of Cardiac Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis.

BACKGROUND: The aim of this study was to assess the echocardiographic characteristics of chronic hemodialysis (HD) patients with end-stage renal disease (ESRD) in a multicenter prospective cohort study.Methods and Results:Three hundred and fifteen patients with ESRD (67.9±10.6 years, 47.6% male) on chronic HD for ≥1 year were examined on transthoracic echocardiography, including Doppler-derived aortic valve area (AVA) measurement. Only 11.5% and 3.4% of all patients had normal left ventricular (LV) geometry and normal LV filling pattern, respectively. The majority of patients had aortic and mitral valvular calcification, and approximately 50% of all 315 patients had aortic valve narrowing with AVA <2.0 cm2. Patients were divided into 3 groups according to AVA index tertile: group 1, highest tertile; group 2, middle tertile; and group 3, lowest tertile. Group 3 was older, had a greater cardiothoracic ratio on chest X-ray, higher plasma brain natriuretic peptide and total LV afterload, and lower stroke volume index than the other 2 groups. Age and intact parathyroid hormone (PTH) level were independently associated with low AVA index. CONCLUSIONS: Patients with ESRD on chronic HD have a high prevalence of cardiac structural and functional abnormalities including calcified aortic sclerosis. High age and PTH were associated with aortic valve narrowing in these patients.

Homologue and isomer distribution of dioxins observed in water samples collected from Kahokugata Lagoon and inflowing rivers, Japan.

Water samples were collected at 17 sites in Kahokugata Water Basin, a closed water basin in central Japan. We determined the concentration of dioxins of the water samples. Linear relationships between toxic equivalent (TEQ) concentrations of dioxin and concentrations of suspended solid (SS) were obtained at sites in Kahokugata Lagoon and in the rivers flowing into the lagoon. Homologue composition of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) indicated that all the water samples were still strongly influenced by chlorinated herbicides, such as chloronitrofen (CNP) and pentachlorophenol (PCP) that had been widely used in rice fields. The main isomer distributions of the PCDD homologues were not significantly different among the sampling sites, while the main isomer distributions of the PCDF homologues were considerably different among the sampling sites. At a few sampling points in the downstream part of one of the rivers, high concentrations of 1,3,6,7,8-pentachloro dibenzofuran (1,3,6,7,8-PeCDF) and its related isomers (1,3,6,8-chlorine-substituted PCDFs) were traced to a dye manufacturing plant. These non-toxic isomers are usually only minor constituents in environmental water samples and are not indicators of any known dioxin sources. The dyeing discharge was found to make a contribution only in the water samples collected near the plant and the seasonal variation of the contribution might depend on the flow rate of the river.

Improvement of endocardial border delineation during dobutamine stress echocardiography with Levovist.

OBJECTIVES: This study evaluated whether the use of Levovist improves endocardial border delineation during dobutamine stress echocardiography. METHODS: Thirty patients (20 men and 10 women) were enrolled in this study. Dobutamine was infused intravenously using an incremental regimen of 5, 10, 20, 30, and 40 micrograms/kg/min, each dose for 3 min. Levovist (277 mg/ml), dissolved in 9 ml of 5% dextrose, was infused intravenously. Two ml was infused at rest, 10, and 20 micrograms/kg/min. Three ml was infused at peak dobutamine dosage. Echocardiograms were recorded on videotapes. A endocardial border delineation score index (EDSI) was used for image analysis. The EDSI was obtained from each of 12 segments of the left ventricular wall (30 patients) in the rest and peak stress periods, before and after Levovist. Data from a total of 1,440 segments were analyzed separately. RESULTS: The mean EDSI at rest was 2.2 +/- 0.6 without contrast medium, and 2.4 +/- 0.7 with contrast medium (p < 0.05). The mean EDSI during peak stress was 2.0 +/- 0.7 without contrast medium, and 2.2 +/- 0.6 with contrast medium (p < 0.05). The wall-by-wall EDSI revealed that the delineation of apical-septal, mid- and apical-lateral, apical-inferior, and apical-anterior segments was improved significantly with Levovist in the rest and peak stress periods. CONCLUSIONS: Delineation of the apical-septal, mid- and apical-lateral, apical-inferior, and apical-anterior segments was improved significantly with Levovist during dobutamine stress echocardiography.