Koichiro Sonoda

Evaluation of venous thromboembolism and coagulation-fibrinolysis markers in Japanese patients with inflammatory bowel disease.

BackgroundArterial or venous thromboembolism is rarely encountered clinically as an extradigestive tract complication in inflammatory bowel disease (IBD). However, it is one of the important prognostic factors for IBD patients. The present study was designed to evaluate the relationship between pulmonary embolism (PE) and deep vein thrombosis (DVT) with coagulation-fibrinolysis markers in patients with active IBD.MethodsIn 47 consecutive cases hospitalized due to active IBD [26 with Crohn’s disease (CD) and 21 with ulcerative colitis (UC)], we evaluated the disease severity, blood tests, pulmonary ventilation-perfusion scan (V/Q scan), and magnetic resonance venography (MRV) or conventional venography.ResultsPE was diagnosed by V/Q scan in 5 (2 with CD and 3 with UC; 10.6%). DVT was diagnosed in 5 (2 with CD and 3 with UC; 10.6%). Of the 47 patients, 8 (17.0%) had venous thromboembolism (either PE or DVT), and 2 of them (4.3%) had both conditions. In UC patients, the thrombosis group was in more severe stages based on endoscopic grading than the nonthrombosis group. In all patients, the thrombosis group were older (50.3 ± 14.3 years) than the nonthrombosis group (29.2 ± 11.7 years). Furthermore, the thrombosis group had higher thrombin–antithrombin III complex (13.1 ± 17.7 ng/ml) and d-dimer (964 ± 1402 ng/ml) values than the nonthrombosis group (5.3 ± 5.5 ng/ml, P = 0.0245, and 207 ± 192 ng/ml, P = 0.0016, respectively). There were no significant differences in leukocyte and platelet counts, C-reactive protein, and fibrinogen between the two groups.ConclusionsA high incidence of venous thromboembolism was suggested in Japanese patients with active IBD. We should be careful with thrombosis in treatment of IBD patients, especially those who are of older age and in more severe stages.

Superior Rhythm Discrimination With the SmartShock Technology Algorithm ― Results of the Implantable Defibrillator With Enhanced Features and Settings for Reduction of Inaccurate Detection (DEFENSE) Trial ―

BACKGROUND Shocks delivered by implanted anti-tachyarrhythmia devices, even when appropriate, lower the quality of life and survival. The new SmartShock Technology®(SST) discrimination algorithm was developed to prevent the delivery of inappropriate shock. This prospective, multicenter, observational study compared the rate of inaccurate detection of ventricular tachyarrhythmia using the SST vs. a conventional discrimination algorithm.Methods and Results:Recipients of implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy defibrillators (CRT-D) equipped with the SST algorithm were enrolled and followed up every 6 months. The tachycardia detection rate was set at ≥150 beats/min with the SST algorithm. The primary endpoint was the time to first inaccurate detection of ventricular tachycardia (VT) with conventional vs. the SST discrimination algorithm, up to 2 years of follow-up. Between March 2012 and September 2013, 185 patients (mean age, 64.0±14.9 years; men, 74%; secondary prevention indication, 49.5%) were enrolled at 14 Japanese medical centers. Inaccurate detection was observed in 32 patients (17.6%) with the conventional, vs. in 19 patients (10.4%) with the SST algorithm. SST significantly lowered the rate of inaccurate detection by dual chamber devices (HR, 0.50; 95% CI: 0.263-0.950; P=0.034). CONCLUSIONS Compared with previous algorithms, the SST discrimination algorithm significantly lowered the rate of inaccurate detection of VT in recipients of dual-chamber ICD or CRT-D.

Comparison of Neointimal Tissue Characteristics Between Bare-metal and Second-generation Drug-eluting Stents Nine Months after Implantation in Patients with ST-segment Elevation Myocardial Infarction

Background: Neointimal tissue characteristics after implantation of stents are related to late/ very late stent thrombosis and/ or restenosis of target lesion. However, the difference of them has not been fully elucidated among bare-metal stents (BMS) and second-generation drug-eluting stents (DES). Methods: The present study uses optical coherence tomography (OCT) to compare neointimal tissue characteristics among BMS (n = 22), Endeavor zotarolimus - (E-ZES; n = 21), everolimus - (EES; n = 22) and biolimus A9 - (BES; n = 23) eluting stents in the patients with STEMI who underwent follow-up coronary angiography at nine months after stent implantation. Results: Quantitative coronary angiography revealed significantly higher restenosis rates for BMS and E-ZES than EES and BES. OCT showed significantly lower and higher rates for covered and uncovered EES, respectively, than for BMS and E-ZES. The malapposition rate for E-ZES was significantly lower than those of other two types of DES. The neointima of EES and BES was significantly thinner than that of BMS and E-ZES. Evagination was more prevalent in BES among the four stents, and the rate of evagination/strut significantly correlated with positive remodeling (r = 0.312, p = 0.006). Conclusion: Neointimal tissue characteristics were different among BMS and second-generation DES at nine months after implantation into patients with STEMI. This might be related to the differences of future cardiac events.

The Value of Lung Perfused Blood Volume Computed Tomography in Selecting the Target Lesions for the Effective Treatment of Chronic Thromboembolic Pulmonary Hypertension

Pulmonary endarterectomy is a conventional definitive therapeutic strategy for the treatment of chronic thromboembolic pulmonary hypertension.1 Several reports recently demonstrated that balloon pulmonary angioplasty (BPA) improves clinical status and hemodynamics in patients with chronic thromboembolic pulmonary hypertension.2 Because the success of reperfusion of occluded pulmonary vessels is considered to depend on the patency of the distal vessels via the systemic collateral circulation, the assessment of regional pulmonary perfusion is important for the selection of the candidates when performing either BPA or pulmonary endarterectomy. Lung perfusion scintigraphy cannot provide information regarding lung perfusion via the systemic collateral circulation. Lung perfused blood volume computed tomography (PBV-CT) is useful for the assessment of lung perfusion in occluded areas during the pulmonary arterial phase and the systemic arterial phase.3 A 73-year-old man was referred to …