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AimsThe aim of the present study was to evaluate the procedural feasibility, the safety and the 1-year outcome following left atrial appendage (LAA) closure using the Amplatzer cardiac plug (ACP) in Belgium.Methods and resultsData were prospectively collected among 90 consecutive patients, undergoing LAA closure with an ACP in 7 Belgian centres between June 2009 and September 2012. The patients (56 males, 74 ± 8 years) were at high risk for stroke (CHA2DS2-VASc = 4.4 ± 1.8) and bleeding (HAS-BLED = 3.3 ± 1.3). Technical success was obtained in all but one patient and procedural success was 95%. Procedural major adverse events (MAE) were 3 tamponades resulting in death in one case. Minor complications were 3 insignifi cant pericardial eff usions, 2 transient myocardial ischaemia due to air embolism and 1 femoral pseudoaneurysm. At 1-y follow-up, there were 4 deaths, 2 minor strokes, 1 tamponade and 1 myocardial infarction. Overall survival was 94% and freedom from MAE was 88%. In our population, the expected annual stroke risk according to the CHA2DS2-VASc score was 5.08%, while the observed stroke rate was 2.14%/year.ConclusionsThe Belgian registry shows that LAA closure using the ACP device is feasible and safe. At 1-y follow-up, the observed stroke rate was 2.14%/year, less than predicted by the CHA2DS2-VASc score. Longer follow-up is needed to evaluate the long-term safety and its effi cacy in reducing stroke.

Objective— To identify cTnI rise after percutaneous ISD closure and to determine its prognostic significance.Background— Cardiac troponin-I (cTnI) is a very specific and sensitive marker of myocardial injury. A significant increase of cTnI levels after percutaneous interatrial septal defect (ISD) closure has been reported.Methods— Patients admitted for transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure, were enrolled in this prospective study. Standard protocol was unchanged, except for blood sampling, to which serial cTnI before, 6, and 24 hours after the procedure was added.Results— Seventy-eight patients (female/male 37/41, mean age 55 ± 13 y, 14 ASD and 64 PFO) were included. In none of the patients cTnI was elevated before the procedure and in no patients a cTnI rise above the WHO-criteria for myocardial infarction (>= 0.4 ng/ml) was seen. However, in 32 patients (41%) minimal cTnI rise (range from 0.04 ng/ml to 0.37 ng/ml) was present within a time frame of 24 hours.The increase in cTnI was not related to peri-procedural complications and to short-term outcome (mean follow-up time of 7 ± 5 months).In addition, cTnI rise was significantly related with the presence of hyperlipideamia (P = 0.004), device size (P = 0.008), and the absence of balloon sizing (P = 0.017).Conclusions— Transcatheter closure of ISD seems to be a safe procedure. A minimal but significant increase of cTnI is noted in some patients after the procedure, but it seems not to be related to short-term prognosis. However, cTnI rise is clearly associated with patients’ characteristics and peri-procedural variables.

Objective— A prospective randomized multicentre pilot trial, comparing stenting with balloon angioplasty as a treatment for coronary lesions, located in a bifurcation was performed.Methods and results— After balloon dilatation, with a < 30% residual stenosis in the main vessel and < 50% residual stenosis in the side branch, patients were randomized to stay in a “balloononly” group or to stenting. The stents used were the AVE S 670 for the main vessel and the Bestent, if needed, for the side branch. The primary end point was the incidence of major adverse cardiac events (MACE) at 6 months, secondary end points were in-hospital MACE, acute angiographic results, use of materials and duration of the procedure. One hundred eleven patients were randomized: 55 in the balloon group, 56 in the stent group. No differences in MACE-rates were found at 6 months (22% versus 20%, p = 0.78).The target vessel revascularization rate was 16% in the balloon group and 12.5% in the stent group (p = 0.56). The acute angiographic results were significantly better in the stent group (residual stenosis 8% versus 26% [p < 0.05]). More materials were used, with a near doubling of the duration of the procedure in the stent group (p < 0.05).Conclusions— Although stenting resulted in better immediate angiographic results during percutaneous treatment of lesions located in a bifurcation, as compared to balloon angioplasty alone, clinical events were comparable in the two treatment arms.

We describe the case of an elderly man who was admitted to our hospital with the diagnosis of an acute anterior myocardial infarction, together with an acute bioccipital ischaemic stroke. Coronary angiography revealed embolization of the distal left anterior descendens and the first septal branch. The definite diagnosis of paradoxical embolism was made by means of a transoesophageal echocardiography which demonstrated a large snake-like floating thrombus crossing a patent foramen ovale. This diagnosis was also supported by the presence of deep venous thrombosis as a probable origin of the intra-atrial thrombus and the secondary pulmonary embolism which contributed to the elevated right heart pressure.The patient was treated with full-dose heparin and subsequently oral anticoagulation. After discharge, follow-up by transoesophageal echocardiography was organized and once the intracardiac thrombus had disappeared, elective transcatheter closure of the patent foramen ovale was performed.

Objective— Hypercholesterolaemia is associated with a loss of endothelium-dependent vasodilation, which may facilitate the occurrence of myocardial ischaemia in patients with coronary artery disease (CAD). The improvement of endothelial dilator function after 4 to 6 weeks of oral lipidlowering therapy has been documented. Whether this early restoration of endothelial function by statins translates into anti-ischaemic effects is unknown.This study was designed to determine the effect of 4 weeks’ treatment with 80 mg atorvastatin daily on exercise-induced ischaemia in patients with stable ischaemic heart disease (IHD) receiving standard anti-anginal drug therapy.Methods and results— A total of 41 patients with documented CAD, exercise-induced ischaemia and LDL-cholesterol > 130 mg/dl underwent exercise ECG, angina score and lipid level assessment at baseline, after 4 weeks of placebo treatment, and after 4 weeks of therapy with atorvastatin 80 mg. Primary endpoint was the change in time to 1 mm ST-segment depression (= ischaemic threshold) between placebo and treatment period.Atorvastatin treatment resulted in a 55% reduction of low-density lipoprotein (LDL) cholesterol (from mean of 162 (SD 32) to 72 (20) mg/dl). For a comparable rate-pressure product, the average time to 1 mm ST-segment depression was 295 (112) s at baseline, 314 (149) s after placebo and 301 (131) s after atorvastatin, indicating that the ischaemic threshold was not significantly modulated after 4 weeks of atorvastatin treatment.There was also no significant change in global angina score or in time to maximal ST-segment depression.Conclusions— High-dose atorvastatin treatment for 4 weeks drastically reduced LDLcholesterol. However, the present study did not demonstrate a significant effect on the ischaemic threshold in patients with stable IHD already under treatment with anti-ischaemic agents.