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Mucus volume in both central and peripheral airways was assessed in 13 patients, six with chronic bronchitis (CB) and seven with chronic pulmonary emphysema (CPE), by morphologic quantitative measurement in autopsied lungs, and the results were compared with those from four control lungs (NL). The patients with CB and CPE had severe obstructive impairment that did not differ significantly between the two groups (FEV1%, mean 45% in CB and mean 49% in CPE). Mucous hypersecretion during clinical remission differed significantly between the CB and CPE groups (mean 80 ml/day in CB and mean 8 ml/day in CPE). The length of the airway basement membrane and the area of mucus were measured with a digitizing computer. The volume ratio of mucus to airway lumen, which was defined as the volume ratio of mucus to airway lumen calculated as a cylinder by the length of basement membrane, was regarded as the mucus occupying ratio (MOR). MOR was significantly higher in CB lungs (4.1 +/- 1.0% in central airways and 19.6 +/- 3.8% in peripheral airways, mean +/- SE) than in NL (0.3 +/- 0.1% in central airways and 0.6 +/- 0.3% in peripheral airways, respectively) in both central and peripheral airways (p less than 0.05 and p less than 0.01, respectively), whereas no significant increase in MOR was found in CPE lungs, compared with NL. Furthermore, peripheral airway MOR was significantly higher than that of central airways in CB lungs (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Some have hypothesized that the use of angiotensin‐converting enzyme inhibitors (ACEI) and angiotensin‐receptor blockers (ARB) may modify susceptibility to coronavirus disease‐2019 (COVID‐19) in humans. Thus, we conducted two meta‐analyses to investigate the effect of ACEI and ARB on mortality and susceptibility to COVID‐19. Pubmed and EMBASE were searched through June 2020 to identify clinical trials that investigated the testing positive and in‐hospital mortality rates for COVID‐19 for those who were treated with ACEI and/or ARB and for those who were not treated with ACEI or ARB. The first analysis investigated the testing positive rate of COVID‐19. The second analysis investigated the in‐hospital mortality rate for patients with COVID‐19. Three eligible studies for the first analysis and 14 eligible studies for the second analysis were identified. The first analysis demonstrated that the use of ACEI or ARB did not affect the testing positive rates (odds ratio [OR] [confidence interval [CI]] = 0.96 [0.88–1.04]; p = .69, OR [CI] = 0.99 [0.91–1.08]; p = 0.35, respectively). The second analysis showed that the use of ACEI and/or ARB did not affect in‐hospital mortality (risk ratio [RR] 95% [CI]] = 0.88 [0.64–1.20], p = 0.42). The subgroup analysis by limiting studies of patients with hypertension showed ACEI and/or ARB use was associated with a significant reduction of in‐hospital mortality compared with no ACEI or ARB use (RR [CI] = 0.66 [0.49‐0.89], p = 0.004). Our analysis demonstrated that ACEI and/or ARB use was associated neither with testing positive rates of COVID‐19 nor with mortality of COVID‐19 patients.

See an invited perspective on this article on page 781.Diastolic dysfunction is important in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Sympathetic nervous hyperactivity may contribute to the development of diastolic dysfunction. The aim of this study was to determine the relationship between myocardial sympathetic innervation quantified by 11 C-hydroxyephedrine PET and diastolic dysfunction in HFpEF patients. Methods: Forty-one HFpEF patients having an echocardiographic left ventricular ejection fraction of 40% or greater and 12 age-matched volunteers without heart failure underwent the echocardiographic examination and 11 C-hydroxyephedrine PET. Diastolic dysfunction was classified into grades 0-3 by Doppler echocardiography. Myocardial sympathetic innervation was quantified using the 11 C-hydroxyephedrine retention index (RI). The coefficient of variation of 17-segment RIs was derived as a measure of heterogeneity in myocardial 11 C-hydroxyephedrine uptake. Results: Grade 2-3 diastolic dysfunction (DD 2-3 ) was found in 19 HFpEF patients (46%). They had a significantly lower global RI (0.075 6 0.018 min 21 ) than volunteers (0.123 6 0.028 min 21 , P , 0.001) and HFpEF patients with grade 0-1 diastolic dysfunction (DD 0-1 ) (0.092 6 0.024 min 21 , P 5 0.046). HFpEF patients with DD 2-3 had the largest coefficient of variation of 17-segment RIs of the 3 groups (18.4% 6 7.7% vs. 14.1% 6 4.7% in HFpEF patients with DD 0-1 , P 5 0.042 for post hoc tests). In multivariate logistic regression analysis, a lower global RI (odds ratio, 0.66 per 0.01 min 21 ; 95% confidence interval, 0.38-0.99; P 5 0.044) was independently associated with the presence of DD 2-3 in HFpEF patients. Conclusion: Myocardial sympathetic innervation was impaired in HFpEF patients and was associated with the presence of advanced diastolic dysfunction in HFpEF.

• Delayed contrast-enhanced CT (DE-CT) can be applied to patients with implantable devices. • DE-CT can detect cardiac sarcoidosis (CS) lesions similarly to cardiac MRI. • DE-CT shows high sensitivity for detecting CS. • DE-CT may be useful particularly in patients with contraindications to cardiac MRI.

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