The 16th Annual Scientific Meeting � JHFS S123

Special Session 1

SS1-1The Great East Japan Earthquake Increased the Incidence of Heart FailureHITOSHI SUZUKI, SHINYAYAMADA, YOSHIYUKI KAMIYAMA, TAKAHIROYAMAKI, KOICHI SUGIMOTO, HIROYUKI KUNII, KAZUHIKO NAKAZATO,SYUICHI SAITO, YASUCHIKA TAKAISHIDepartment of Cardiology and Hematology, Fukushima Medical University,Fukushima, Japan

Background: The Great East Japan Earthquake on March 11, 2011, induced phys-ical and mental stresses to residents in Fukushima Prefecture, Japan. Althoughseveral studies have revealed that stress in catastrophic disasters can trigger car-diovascular events, little is known about the association with the occurrence ofheart failure. The purpose of this study was to determine whether this earthquakeincreased the incidence of acute decompensated heart failure in patients withchronic heart failure (CHF). Furthermore, we examined whether remote monitor-ing of implantable device was effective for the management of CHF. Methods:Forty five CHF patients who received implantable devices capable of intrathoracicimpedance using remote monitoring were enrolled. When accumulated imped-ance under reference impedance got over 60 ohms (Fluid Index threshold), we de-fined the existence of pulmonary congestion. We compared the incidence ofpulmonary congestion and arrhythmic events between 30 days before and afterMarch 11. Results: In the 30 days after March 11, 10 patients exceeded the FluidIndex threshold compared with 2 patients in the preceding 30 days (P!0.05). Onthe contrary, arrhythmic events did not change after March 11. Conclusions:These results suggest that earthquake-induced stress causes an increased risk ofworsening heart failure without changes in arrhythmia. In addition, remote mon-itoring of intrathoracic impedance may be a useful tool for the management ofCHF in catastrophic disasters.

SS1-2The Great East Japan Earthquake and Cardiovascular DiseasesSATOSHI YASUDADepartment of Cardiovascular Medicine, National Cerebral and CardiovascularCenter, Suita, Japan

The Great East Japan Earthquake on March 11, 2011 was one of the most cata-strophic disasters on record, devastating the northeastern coast region of Japan.Since peoples have suffered from both physical and psychological stress and en-vironmental change, this particular disaster of earthquake, tsunami and nuclearpower plant accident adversely affect cardiovascular diseases. It is important toclarify the earthquake-associated cardiovascular risk in the clinical study. There-fore, multicenter study has been organized and supported by the Ministry ofHealth, Labor and Welfare, which may contribute to the improvement of disastermedicine in the future.

SS1-3Impact of Earthquakes on Pathogenesis of Takotsubo CardiomyopathyTOHRU MASUYAMA, MIHO FUKUI, SHINICHI HIROTANICardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan

In the early 1990s, Sato et al first reported takotsubo cardiomyopathy (TC), whichappeared to be triggered by acute emotional and physical stress. Thereafter, thissyndrome has gradually attracted scientists’interest. Nowadays, TC is widely rec-ognized and reported from all over the world. This syndrome was initially namedas TC because of left ventricular shape. However, TC has increasingly been re-ferred to as Stress-related cardiomyopathy, transient left ventricular apical bal-looning and neurogenic stunned myocardium, reflecting pathogenesis.Epidemiological studies have revealed that disasters such as earthquakes can bea cardiovascular risk. For example, sudden death and acute myocardial infarctionincreased after the Hanshinawaji earthquake and the Los Angeles earthquake. TCwas reported to increase after the Chuetsu earthquake occurred in 2004. Precisereports of the Higashinihon earthquake on cardiovascular risks have yet tocome. However, I convince that the earthquake, giving a lot of mental and physicalstress to suffered people, caused a lot of cardiovascular disease including TC. Thepurpose of this talk is to review effects of earthquakes on TC and to provide an up-to-date review of the mechanism causing TC.

SS1-4Takotsubo Cardiomyopathy and Sudden Cardiovascular Death Triggered byNiigata-Chuetsu EarthquakeMAKOTO KODAMA1, HIROSHI WATANABE1, YOSHIFUSA AIZAWA2

1Division of Cardiology, Niigata University Graduate School of Medical and DentalSciences, Niigata, Japan, 2CardiovascularCenter, TachikawaGeneralHospital,Nagaoka,Japan

Earthquake and natural disaster cause occasionaly catastrophic cardiovascular events.An intense earthquake magnitude 6.8 on Richter scale (grade 7 of seismic intensity)occurred in Niigata Chuetsu distinct at 5:56 p.m. on October 23, 2004. Subsequently,about 90 aftershocks including three strong earthquakes over magnitude 6.0 occurredduring the following weeks. We retrospectively investigated the incidence of acute cor-onary syndrome, Takotsubo cardiomyopathy and sudden death triggered by the earth-quake. The number of total cardiovascular events markedly increased after theearthquake with a daily median of 6 cases compared with median of 2 cases in the con-trol 20 weeks. There was no statistical difference in the incidence of acute coronarysyndrome after the earthquake compared with the control periods. Takotsubo cardio-myopathy dramatically increased to 25 cases during 4 weeks after the earthquake com-pared with only 2 cases in the control 20 weeks. Twenty-four cases were women, andthe mean age was 71.0 years (rage 49-83 years). The incidence of sudden death alsoincreased in the week after the earthquake, with a daily median of 3 cases comparedwith median of 1 case in the prior 4 weeks. The increase of sudden death was dispro-portionately high than the increase of acute coronary syndrome. Takotsubo cardiomy-opathy may be one of the causal disorders of sudden death after the great disaster.

SS1-5Comparison of the Incidence of Acute Decompensated Heart Failure Before andAfter the Major Tsunami in Northeast JapanSATOSHI NAKAJIMA1, MIHO HONMA1, FUMITAKA TANAKA1, TOSHIAKISAKAI2, HIROSHI ENDOU3, MASAYUKI ONODERA4, MIKIO KAWAKAMI5,YOSHIHIRO MORINO1, MOTOYUKI NAKAMURA1

1Department of Internal Medicine, Iwate Medical University, Morioka, Japan, 2IwatePrefectural Ninohe Hospital, Ninohe, Japan, 3Iwate Prefectural Ofunato Hospital,Ofunato, Japan, 4Iwate Prefectural Kuji Hospital, Kuji, Japan, 5Iwate PrefecturalKamaishi Hospital, Kamaishi, Japan

On 11 March 2011, a huge tsunami attacked the northeastern coast of Japan follow-ing a magnitude 9 earthquake. No reports have investigated the impact of tsunamis onthe incidence of heart failure. We have investigated the number and clinical charac-teristics of hospitalized patients with acute decompensated heart failure (ADHF) inthe east coast of Iwate hit by the tsunami (tsunami area) for 12-week period aroundthe disaster. For comparison with previous years, numbers of ADHF were surveyed inthe corresponding area and periods in 2009 and 2010. In addition, to elucidate theimpact of the tsunami, a similar study was performed in a remote area where the tsu-nami had minimal effect (control area). After the disaster, the number of patients withADHF in the tsunami area was significantly increased compared to the pre-disasterperiod (relative risk5 1.97). The peak was found 3-4 weeks after the disaster. In con-trast, in the control area, no significant change in ADHF events was observed. Therewas a significant correlation between changes in the number of ADHF admissionsand the percentage of tsunami flood area or the number of shelter evacuees (both,p!0.001). These findings suggest that large and sudden changes in daily life andthe trauma associated with a devastating tsunami have a significant impact on the in-cidence of ADHF.

SS1-6Increased Incidence of Heart Failure in the East Japan EarthquakeTATSUO AOKI, YOSHIHIRO FUKUMOTO, SATOSHI YASUDA, YASUHIKOSAKATA, KENTA ITO, JUN TAKAHASHI, HIROAKI SHIMOKAWADepartment of Cardiovascular Medicine, Tohoku University Graduate School ofMedicine, Sendai, Japan

Background: Although it was previously reported that various cardiovascular dis-eases were increased after earthquakes, the relation between earthquake and heartfailure (HF) remains to be clarified. In this study, we examined whether the incidenceof HF was increased after the Great East Japan Earthquake (March 11, 2011).Methods and Results: We retrospectively analyzed 124,152 transport records of am-bulance from 11th February to 30th June in 2008-2011 in Miyagi prefecture, which