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Introduction Aortic dilatation is a common finding in patients with aortic valve disease or genetic connective tissue disease, such as Marfan’s. It is known that dilatation of the aorta is a precursor for life threatening aortic aneurysm leading to rupture or dissection (1,2,3). The ESC recommends that in patients with Marfan’s syndrome, surgical intervention is offered once the aortic diameter is >50mm or >45mm if other risk factors are present, and in patients with bicuspid aortic valve, once the aortic diameter reaches >55mm or >50mm if other risk factors present (1). There is currently a lack of literature on the incidence of aortic dilatation in the general or even hospital population though there has been data suggesting an incidence of aortic aneurysm to be 5.9 cases per 100,000 (2). In patients with hypertension, the prevalence of aortic dilatation was reported to be as high as 12% (3). The aim of our project was investigate the incidence of aortic dilatation by echocardiography in our hospital population which may lay the foundation for population study. Methods A randomised retrospective review was carried out using the electronic echocardiogram database at our hospital. Echocardiograms performed on every Thursday between 1st October 2016 and 1st April 2018 were included in this study. Aortic dilatation was defined if the aortic root was >3.8 cm, or ascending aorta>3.6 cm. Along with echocardiographic analyses, basic patient demographic variables including age and gender were recorded. Results A total of 2150 echocardiograms were analysed over the 18 months. The median age of our cohort was 69 years (22 - 94). 66% of our patients were males and 34% females. 146 patients were found to have aortic dilatation. Therefore, the incidence of aortic dilatation was 6.8% in our study population. Conclusion The incidence of aortic dilatation in our hospital population of 6.8% was significantly higher than we expected. It is a staggering 1000 fold increase when compared to current literature surrounding the incidence of aortic aneurysm which is the possible end point of aortic dilatation(1,2). Based on the incidence established in this study, our hospital alone would have at least 400 patients with a dilated aorta in a year. Due to the potential detrimental prognosis of aortic dilatation, further investigations are certainly warranted to identify risk factors related to the development and progression of aortic dilatation as well as the pattern of progression. References Authors/Task Force members, et al. ‘2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).’ European heart journal 35.37 (2014): 2541–2619. Coady, Michael A., et al. ‘Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections.’ Cardiology clinics 17.4 (1999): 615–635. Cuspidi, Cesare, et al. ‘Aortic root dilatation in hypertensive patients: a multicenter survey in echocardiographic practice.’ Blood pressure 20.5 (2011): 267–273. Conflict of Interest Nil

The production of autoantibodies against a vast array of self antigens, most notably double stranded (ds) DNA, characterized systemic lupus erythematosus (SLE). The purpose of this work is to study specific Ig fractions isolated from normal human serum (NHS) and their effect on the binding of anti-double-stranded deoxyribonucleic acid (dsDNA) antibodies (Abs) to dsDNA. A fraction named immunoglobulin G (IgG)-reactive IgG was purified from total NHS IgG by absorption onto (CNBr)-activated Sepharose 4B linked to intact IgG molecules (IgG-Sepharose column). IgG-reactive IgG was co-incubated with systemic lupus erythematosus (SLE) patients serum and binding of the anti-dsDNA Abs to dsDNA was measured by enzyme-linked immunosorbent assay (ELISA). Co-incubation of SLE patients serum with IgG-reactive IgG resulted in a dose-dependent reduction in binding of anti-dsDNA Abs to dsDNA. A reduction greater than 70% was observed at a concentration of 300 mu g of IgG-reactive IgG per mL of a 400-fold diluted SLE patients serum whereas total NHS IgG, at the same concentration, resulted in a 10% reduction in binding. The purification process used to isolate IgG-reactive IgG was based on interactions between intact Ig rather than on interactions between F(ab)(2) portions. IgG(2) is the predominant immunoglobulin (Ig) subclass in IgG-reactive IgG. Thus, IgG(2) might have an important role in the connectivity characteristics of NHS IgG. The capacity of IgG-reactive IgG to inhibit anti-DNA Ab binding to dsDNA may have potential application in the treatment of SLE. This targeted biological approach may provide an alternative strategy to immunosuppressants. (C) 2011 Elsevier GmbH. All rights reserved.

The clinical treatment of cerebral aneurysms, from detection to post-intervention follow-up care, poses a series of challenges, both clinical and technical. The introduction of computational simulation techniques, in all stages of the procedure, allows for, or promises to provide, patient-specific risk evaluation, rationalisation and optimisation of surgical or interventional planning and a priori evaluation of treatment efficacy and long-term outcome. In this article, we present techniques that allow for the simulation of growth of cerebral aneurysms, based on detailed vascular wall remodelling techniques. Moreover, we demonstrate that computational techniques allow the preinterventional evaluation of the effectiveness of detachable coil implantation. Finally, appropriate coupling of the haemodynamics of flow with thrombosis models allows for the prediction of the growth of clot; of great importance both of the eventual healing of the lesion in case of endovascular coil treatment for cerebral aneurysms but also as an indicator of the spontaneous formation of microembolic clots. © 2009 Taylor and Francis.

Article history: Received 14 October 2015 Accepted 18 October 2015 Available online 21 October 2015 treating extremely long PR interval by pacing. In addition to PR/heart rate slope, we agree that other factors such as the presence of diastolic mitral or tricuspid regurgitation, overall ventricular function and patients' symptoms should be considered in deciding permanent pacing in such patients. Having considered all the above, the PR/heart rate relationship may well remain an objective index to help decide permanent pacing in patients with an extremely long PR interval before more

ObjectivesWe sought to determine whether there are age-related differences in vasovagal syncope.BackgroundIn those with suspected vasovagal (neurocardiogenic) syncope, tilt testing demonstrates different hemodynamic responses. These responses may be age related, reflecting differing underlying pathophysiology.MethodsUsing a two-stage tilt protocol with glyceryl trinitrate (GTN) provocation, 505 consecutive syncopal patients were studied. Their baseline characteristics and hemodynamic responses during both early and tilt-induced collapse were analyzed. Hemodynamic responses were classified using the VAsovagal Syncope International Study (VASIS) criteria: mixed, cardioinhibition, severe cardioinhibition/asystole, pure vasodepression, chronotropic incompetence, and excessive heart rate rise. Multivariate regression analyses were performed to determine the associations of the baseline clinical characteristics (including age) and the tilt-induced hemodynamic responses.ResultsThirty-three patients were unable to tolerate tilt testing. Age was independently associated with distinct responses during tilt. Chronotropic incompetence was predicted by increasing age (odds ratio [OR] 1.04, p < 0.0002). Younger age predicted an excessive heart rate rise (OR 0.97, p < 0.0005). Pure vasodepression was more common in the older group (>65 years; OR 29.5, p < 0.0001), whereas severe cardioinhibition was much less common in the older age group (OR 0.18, p < 0.0001).ConclusionsThere appear to be distinct pathophysiologies underlying vasovagal syncope in different age groups. Young people appear to have excessive cardiac and autonomic responses to stress, whereas older patients appear to have a more generalized cardiovascular decline, with attenuated cardiac and autonomic responses to stress.

Right precordial Q waves are ECG evidence of anterior myocardial infarction and can be present in patients with pathological left ventricular hypertrophy particularly caused by aortic stenosis. The aim of this study was to investigate the ECG features associated with Q waves in aortic stenosis and those in anterior myocardial infarction. We studied 16 patients with anterior myocardial infarction and 19 patients with aortic stenosis by means of ECG, echocardiography and clinical history. On the ECG, heart rate (70 +/- 20 beats/min vs. 83 +/- 20) and QT interval (380 +/- 65 ms vs. 390 +/- 50) did not differ between the two conditions. PR interval (160 +/- 15 ms vs. 185 +/- 30, P0.05) and QRS duration (80 +/- 7.0 ms vs. 95 +/- 15, P0.01) were both longer in patients with aortic stenosis than in those with myocardial infarction. The Q wave voltage in V1 (1.0 +/- 0.55 mV vs. 1.5 +/- 0.60) or V2 (1.3 +/- 0.5 mV vs. 1.8 +/- 0.85) and R wave voltage in V5 (0.7 +/- 0.7 mV vs. 2.1 +/- 0.9) or V6 (0.7 +/- 0.4 mV vs. 1.5 +/- 0.7, all P0.01) were significantly less in patients with anterior myocardial infarction than in those with aortic stenosis. Q wave voltage over 1.3 mV in V1 or R wave voltage over 1.5 mV in V5 can differentiate aortic stenosis from anterior myocardial infarction with a sensitivity of 79% for each and specificities of 81 and 93.8%, respectively. Though the frontal QRS axis was similar in the two groups (28 +/- 45 degrees vs. 14 +/- 35, P0.05), the horizontal QRS axis pointed laterally (-30 +/- 20 degrees) in aortic stenosis and posteriorly (-60 +/- 20 degrees, P0.01) in anterior myocardial infarction. A horizontal QRS axis between zero and -45 degrees detected the presence of aortic stenosis with a sensitivity of 94.7% and a specificity of 81.3%. On echocardiography, left ventricular hypertrophy was found in most patients (94.7%) with aortic stenosis but not in those (0%) with anterior myocardial infarction. Left ventricular end diastolic dimensions (5.1 +/- 0.7 cm vs. 5.1 +/- 0.9, P0.05) were similar in the two groups but the end systolic dimension was increased in patients with aortic stenosis (4.0 +/- 0.9 cm vs. 3.4 +/- 0.6, P0.05). The systolic left ventricular function (shortening fraction: 23 +/- 8.0% vs. 34 +/- 7.0; Vcf: 0.8 +/- 0.26 circ/s vs. 1.3 +/- 0.26, both P0.01) was significantly impaired in patients with aortic stenosis compared to those with myocardial infarction. In conclusion, in the presence of right precordial Q waves, the simple 12-lead ECG can provide important information on distinguishing anterior myocardial infarction from aortic stenosis. In particular, the QRS voltage in the chest leads and horizontal QRS axis can differentiate anterior myocardial infarction from aortic stenosis with high sensitivity and specificity.

In CABRI at 1 year PTCA was associated with greater repeat revascularisation and angina (but not myocardial infarction or death). We determined whether adjusting for baseline risk factors and post revascularisation coronary disease offsets this disadvantage of PTCA.In the CABRI population the crude association of revascularisation mode (i.e. PTCA or CABG) with four clinical outcome (i.e. mortality, myocardial infarction, repeat revascularisation and angina) was adjusted for the baseline risk factors using a logistic regression model for each clinical outcome. A number of measures of angiographic coronary disease were used to assess post revascularisation coronary disease. One at a time, each of these measures was added to each of the four outcome models, to adjust for post revascularisation coronary disease.Comparing adjusted and crude unadjusted association of PTCA with repeat revascularisation there was an increase from 12.8 (P0.0005) (crude relative risk) to 16.7 (P0.0005) (adjusted odds ratio), with angina, from 1.89 (P=0.001) to 1.98 (P0.0019), and with mortality from 1.84 (P=0.092) to 2.15 (P=0.060). PTCA was not significantly associated with myocardial infarction, either crudely or after adjustment.Adjusting for baseline risk factors and post revascularisation coronary disease tended to strengthen rather than weaken associations between PTCA and 1 year mortality, repeat revascularisation and angina at 1 year.

The Coronary Angioplasty vs. Bypass Revascularisation Investigation (CABRI) trial comparing percutaneous transluminal coronary angioplasty (PTCA) with coronary artery bypass grafting did not show a difference in mortality with either procedure. Nonrandomized studies suggest that coronary artery disease (CAD) severity and distribution influences outcome. In the present study we explored the effect of prerevascularization CAD on 1-year mortality in the CABRI population, while adjusting for other baseline variables. Of the 1,054 patients recruited, there were sufficient angiographic results to derive the CAD scores in 974 (92.4%). Of these 974, there were 32 deaths. A number of CAD scores, both weighted for proximal disease (Duke and Leaman) and nonweighted, were used. These scores were then cross-tabulated against mortality. Demographic and clinical variables were also cross-tabulated against mortality and used to derive an initial logistic regression model to predict mortality. The effect of adding each of the CAD scores to this initial model was then assessed. After inclusion of the CAD scores, the best model was: (1) presence of peripheral vascular disease (odds ratio [OR] 3.89, p = 0.0025), (2) previous cerebrovascular accident (OR 2.86, p = 0.043), (3) older age (OR 1.05, p = 0.039), (4) a higher Duke score (OR 2.84, p = 0.0061), and (5) having undergone PTCA (OR 2.12, p = 0.047). In the CABRI population, adjustment for baseline variables, including prerevascularization CAD, revealed significantly higher mortality in those who underwent PTCA than in those who underwent coronary artery bypass grafting.

This study assesses the vasovagal collapse pattern changes, i.e, heart rate (HR) and arterial blood pressure (BP) with a 2-stage tilt-test protocol using glyceryl trinitrate (GTN) provocation. With use of the 45-minute 60 degrees head-up Westminster protocol, 102 consecutive patients were studied. Sublingual GTN 300 microg was given to those with a negative passive tilt. Heart rate and BP patterns were classified according to the Vasovagal International Study classification (VASIS) and then compared between those with a positive passive tilt and those with a positive tilt after having been given GTN. Twelve patients did not tolerate tilt testing, and 16 had a negative response despite taking GTN. Thirty-five patients (20 women and 15 men, mean age 45 +/- 21 years [mean +/- SD]) did not take GTN and 38 (26 women and 12 men, mean age 53 +/- 22 years) had positive passive test results. When comparing the VASIS classification between the 2 groups, results showed: type 1, mixed BP and HR decreased without severe bradycardia (31% [passive] vs 54% [with GTN], p = NS); type 2A, BP decreased before HR decreased (20% vs 22%, p = NS); type 2B, HR decreased before or coincident with BP (34% vs 8%, p = 0.003); type 3, BP decreased without HR decrease (9% vs 0%, p = NS); exception 1, chronotropic incompetence (0% vs 13%, p = 0.026); and exception 2, excessive HR increase (6% vs 3%, p = NS). Thus, GTN use increases frequency of positive results from 34% to 73%. Older people with chronotropic incompetence, who may benefit from pacing, were identified. In younger people there was an increase in those with cardioinhibition.

Restenosis is a major limitation of percutaneous transluminal coronary angioplasty (PTCA). In this study, we assessed the impact of restenosis on PTCA with reference to coronary angioplasty bypass grafting (CABG). In the Coronary Angioplasty versus Bypass Revascularisation Investigation (CABRI) PTCA population, those who had restenosis were defined as those needing a second revascularization at a site revascularized at the initial procedure. The 1-year clinical outcome of the nonrestenotic group (n=437) was compared with those who underwent CABG (n=453). There was no difference in deaths. In the nonrestenotic PTCA group, the incidence of more infarctions was insignificant (relative risk [RR] 1.9, 95% confidence intervals [CI] 0.96 to 3.75, p=0.064), there was a much greater need for repeat revascularization (RR 8.6, CI 5.14 to 14.41, p

Background: Restenosis is a major limitation of angioplasty. In this analysis we assessed the effects of lesion site and quality of dilatation on restenosis rate in the Coronary Angioplasty versus Bypass Revascularization Investigation population who underwent angioplasty. Methods: The angiographic quality of the successful angioplasty revascularization at each site was assessed, and the subsequent restenosis rate was determined. Restenosis was defined by the need for a second angioplasty at the initial site or by surgical coronary bypass grafting at or distal to the initial site. Results: The restenosis rate was unaffected by quality of dilatation but was significantly more common in the proximal left anterior descending artery compared with other sites, whether or not optimal dilatation had been achieved (relative risk 2.0 and 1.9, respectively). Conclusion: Revascularization strategies in multivessel disease should consider the presence or absence of a proximal left anterior descending artery target. Furthermore in studies in which restenosis is an outcome of interest, an allowance should be made for the distribution of target disease. (Am Heart J 1998;135:703-8.)

Objective To determine in patients with coronary heart disease (CHD) and people at high risk of developing cardiovascular disease (CVD) whether the Joint British Societies9 guidelines on CVD prevention (JBS2) are followed in everyday clinical practice. Design A cross-sectional survey was undertaken of medical records and patient interviews and examinations at least 6 months after the recruiting event or diagnosis using standardised instruments and a central laboratory for measurement of lipids and glucose. Settings The ASPIRE-2-PREVENT survey was undertaken in 19 randomly selected hospitals and 19 randomly selected general practices in 12 geographical regions in England, Northern Ireland, Wales and Scotland. Patients In hospitals, 1474 consecutive patients with CHD were identified and 676 (25.6% women) were interviewed. In general practice, 943 people at high CVD risk were identified and 446 (46.5% women) were interviewed. Results The prevalence of risk factors in patients with CHD and high-risk individuals was, respectively: smoking 14.1%, 13.3%; obesity 38%, 50.2%; not reaching physical activity target 83.3%, 85.4%; blood pressure ≥130/80 mm Hg (patients with CHD and self-reported diabetes) or ≥140/85 mm Hg (high-risk individuals) 46.9%, 51.3%; total cholesterol ≥4 mmol/l 52.6%, 78.7%; and diabetes 17.8%, 43.8%. Conclusions The potential among patients with CHD and individuals at high risk of developing CVD in the UK to achieve the JBS2 lifestyle and risk factor targets is considerable. CVD prevention needs a comprehensive multidisciplinary approach, addressing all aspects of lifestyle and risk factor management. The challenge is to engage and motivate cardiologists, physicians and other health professionals to routinely practice high quality preventive cardiology in a healthcare system which must invest in prevention.

Objectives. This study was conducted to determine the procedural success rate, complication rate and long-term outcome of percutaneous transluminal coronary angioplasty in chronically occluded coronary arteries. Background. Coronary angioplasty of chronically occluded vessels has a lower success rate than has angioplasty of nonoccluded vessels, but it is frequently considered safe because the target vesse! is already occluded. The purpose of this study was to determine the reliability of these assumptions at our institution, with the objectives stated above. Methods. We identified from the angioplasty data base at our institution 100 consecutive coronary angioplasty procedures performed between 1987 and 1991 for chronic total occlusion, defined as complete occlusion (Thrombolysis in Myocardial Infarction [TIMI] grades 0 and 1 flow) for ≥3 months. The records of the 95 patients who underwent these procedures were reviewed to determine procedural outcome and medium-term results. Results. Procedural success was obtained in 47 occluded vessels (47%). Significantly fewer successes were obtained in the right coronary artery (26.8%) than in either the left anterior descending (57.1%) or the left circumflex (45%) coronary artery (p < 0.05). A procedural failure without serious adverse consequences occurred in 45 procedures (45%), but in eight patients (right coronary artery in five, left anterior descending artery in three) attempted recanalization was complicated by extensive coronary dissection with acute myocardial ischemia, and one of these patients died. There were no emergency operations, but elective coronary artery bypass surgery was undertaken in 26 patients (in 3 after extensive dissection, in 7 after an apparently good result and in 16 in whom the procedure failed). At 12 months after the procedure, 64.1% of those with a procedural success were event free compared with 32.6% of those whose procedure was both unsuccessful and uncomplicated (p < 0.025) and 25% of those in whom it was unsuccessful and complicated by coronary dissection (p < 0.025). Conclusions. In this series of recanalization of chronically occluded coronary arteries, there was a low procedural success rate, particularly for the right coronary artery. However, when procedural success was obtained, the long-term outlook was good. The overall risk of coronary dissection was comparable to the risk in nonoccluded vessels but was particularly high in the right coronary artery (13%).

Objective: To characterize the functional properties of natural autoantibodies capable of preventing in vitro infection by HIV-1, present in normal human serum (NHS), and denoted as IgG-reactive antibodies. Methods: IgG-reactive antibodies were affinity purified both from normal human serum (NHS) and from a GammaBind G Sepharose Flowthrough (GBF) fraction of NHS by affinity chromatography on IgG coupled to CNBr-activated Sepharose (IgG-Sepharose). Results: The GBF fraction was shown, by Capture ELISA relative to isotype-matched standards, to contain in addition to IgM and IgA isotypes, a low but constant level of IgG isotype. About 15% of the GBF fractions IgG, compared to only about 0.3% of the NHS IgG, was affinity purified on IgG-Sepharose. On IgG subclass analysis, in contrast to the characteristic dominance of IgG1 in pooled NHS, the IgG-reactive antibodies obtained from NHS and from the GBF fraction each showed a dominance of IgG2. Western blot analysis confirmed the abundance of IgG2, a major IgG subclass reactive against carbohydrate antigens, and showed the presence of IgG2 dimers. The IgG-reactive antibodies separated from the GBF fraction were able to neutralize HIV-1BaL strain with approaching 100% and 80% effectiveness at 2μg/ml and 0.6μg/ml, respectively, as well as the primary isolates HIV-1NDK (X4-tropic isolate) and HIV-1JR-CSF (R5-tropic isolate) with an IC50 between 0.4 μg/ml and 1.8 μg/ml for two different preparations. Conclusion: These findings further support our previous proposal for IgG-reactive antibody preparations to be used in the treatment of HIV-1 infected individuals.

Percutaneous transluminal coronary angioplasty may be complicated by the occurrence of major coronary artery dissection, which may precipitate critical myocardial ischemia, necessitating urgent surgical intervention. We report two cases of massive dissection following angioplasty, in which novel methods were used to stabilize arterial integrity. In the first, laser balloon angioplasty was used to repair the dissection; in the other, a coronary stent was inserted. In both cases, coronary artery patency was achieved with reperfusion of the distal coronary bed, thus avoiding the need for acute surgical intervention. Both patients are free of limiting symptoms at follow-up.

In diabetics with coronary artery disease (CAD), there remains uncertainty as to whether revascularization by percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery (CABG) is preferable. To address this, 4-year mortality and level of pre- and postrevascularization angiographic CAD (measured by a series of coronary scores) were compared between both diabetics and nondiabetics and between revascularization modes in the Coronary Angioplasty versus Bypass Revascularization Investigation population as a whole, and then substratified by diabetic status and then by procedure to which they were randomized. The 1,054 randomized subjects contained 125 diabetics (11.9%) who had significantly greater mortality than nondiabetics (RR 2.19, p = 0.001). Among diabetics or nondiabetics, there was no significant mortality difference between those randomized to PTCA versus those to CABG. Diabetics randomized to PTCA and those to CABG had higher mortalities than respective nondiabetics; the association reached significance only in the former (RR 2.41, p = 0.002). All subgroups had similar prerevascularization CAD. Postrevascularization residual CAD was consistently significantly greater in PTCA than in respective CABG subgroups. Most measurements of CAD were greater in diabetic than in nondiabetic subgroups, but none was significant. In the Coronary Angioplasty versus Bypass Revascularization Investigation, diabetics had double the mortality of nondiabetics; this difference was statistically significant both for the entire population and for those randomized to PTCA, but not for those randomized to CABG. Among diabetics or nondiabetics, there was no significant mortality difference between PTCA and CABG. The higher diabetic mortality was more likely related to more rapid disease progression than to greater postrevascularization disease.

UNLABELLED This study examined whether the various hemodynamic collapse patterns observed during tilt testing in patients with suspected neurocardiogenic syncope are relevant when planning therapy, particularly whether a predominantly cardioinhibitory response predicts a beneficial response from pacing. METHODS The effects of temporary atrioventricular (A-V) sequential pacing were studied during tilt testing in 34 patients 48.2 +/- 18.5 years of age. The patient population was divided into a cardioinhibitory group (VASIS classes 2A and 2B) or mixed group (VASIS classes 1 and 3) according to their response to baseline tilt testing. The test was then repeated during A-V pacing with rate hysteresis. A positive response to A-V pacing was defined as a > or = 30-second increase between onset of symptoms and syncope, or mitigation of symptoms compared with the baseline tilt test. RESULTS The study protocol was not successfully completed in three patients. Among the remaining 31 patients, a baseline cardioinhibitory response was observed in 17, and a mixed response in 14 patients. A-V sequential pacing was successful in 13 of 17 patients with a cardioinhibitory response versus 5 of 14 patients with a mixed response (P = 0.024). CONCLUSION The presence of a predominantly cardioinhibitory collapse pattern (VASIS 2A and 2B) during baseline tilt testing doubled the likelihood of successful temporary A-V sequential pacing, and may identify patients with neurocardiogenic syncope most likely to benefit from permanent dual chamber pacing.

A group of patients who did not have restenosis after percutaneous transluminal coronary angioplasty (PTCA) was compared with a group receiving coronary artery bypass grafting (CABG). Restenosis only partially accounted for the greater morbidity after PTCA compared with CABG.

Background The majority of patients with dyslipidemia in the UK are currently treated with a statin. However, many patients do not achieve recommended lipid targets. DYSIS UK was a part of a large multinational Dyslipidemia International Study (DYSIS) conducted in Canada and Europe. The aim was to assess the lipid profile abnormalities in patients on statin medication and the following results are for the UK. Methods DYSIS UK was conducted as a cross sectional study. Patients, men and women, 45 years or older, with a clinical diagnosis of coronary or other atherosclerotic disease, or at high risk of developing cardiovascular disease, were included if they had used statins for at least 3 months. All patients had a clinical examination and their latest lipid values on statin (≥3-month duration) were recorded. Results A total of 1277 patients (mean age 63.5 (SD 9.1) years old; 34.1% female) were enrolled to the study. Coronary heart disease was found in 44.3% of patients, cerebrovascular disease in 5.4% and peripheral arterial disease in 3.4%. Of these patients, 16.9% were current smokers, 39.4% were obese (BMI>30 kg/m 2 ), 60.1% had hypertension, and 27.1% diabetes. The prevalence of lipid abnormalities in statin-treated patients with total lipid profile was: elevated total cholesterol (TC) (≥4.0 mmol/l) 58.2%, low HDL-cholesterol (HDL-C) ( Conclusion The results show that the majority of patients on statin medication (64.4%) do not achieve the recommended lipid targets and/or have abnormal levels of HDL-C and triglycerides. Despite the statin medication, the persistent lipid abnormalities increase the cardiovascular risk in these patients. There is a need for a more comprehensive and intensive lipid management in this high-risk population.

Laser balloon angioplasty involves delivery of continuous wave Nd-YAG laser energy radially from the surface of a specially designed a.ngioplast.y balloon directly to the luniirial surface of an arterial segment immediately after it.s succeasfu] dilatation by conventional balloon angioplasty, the purpose being to fuse loose flaps and disrupted atheroinatous plaque thermally hack against the arterial wall and to reduce elastic recoil and smooth muscle proliferation, in an attempt to prevent re stenosis . Ergonovirie stimulates arterial wall smooth muscle, normally causes arteries to constrict and is used in the diagnosis of coronary artery spasm. Three patients were treated with laser balloon angioplasty, each receiving 380 3 over 20 seconds (30 W for 5 a, 18 W for 5 s & 14 W for 10 5) . The minimum lumirial diameter of the treated arterial segment was measured angiographically before and after conventional balloon angioplasty, immediately after laser balloon angioplasty and again 1 month later both before and after ergonovine was given. The measurements were (respectively, in mm): 1.03, 1.71, 1.85, 2.37 and 2.37 in patient 1; 0.30, 1.54, 1.85, 2.07 and 2.11 in patient 2; and 0.98, 1.76, 2.27, 2.40 and 2.40 in patient 3. The before and after ergonovire measurements were almost identical, suggesting that laser balloon angioplasty abolishes ergonovine responsiveness for at least up to one month following the procedure, and thus might be of use in treating coronary artery spasm which is resistant to medical therapy.

The last decade has been one of uncertainty for laser angioplasty [1]. When serious research work started on the subject, only three lasers were generally available for clinical and experimental use [2], all of which were continuous wave (CW). Of these, light from the C02 laser would not go down a quartz fiber, which left the argon and Nd:YAG lasers as the basic research tools. It quickly became apparent that the light from both these lasers produced unacceptably high levels of surrounding tissue damage, which was demonstrably worse with the Nd:YAG laser [3]. Alternative systems were sought. The work of Deckelbaum et al. in Boston [4] suggested that the use of a pulsed laser might substantially reduce surrounding tissue damage and increase safety margins, which led to investigations in a number of areas. Existing pulsed-laser technology was represented by the solid-state lasers, which form the mainstay of industrial and scientific uses: the ruby, Q-switched Nd:YAG, and Nd:glass lasers.

National Medical Laser Centre. Department of Surgery, The Rayne Institute, UCL, 5University Street, London WC1E 6JJ.ABSTRACTA new ball -tip fibre optic device has been assessed for the purpose of laser angioplasty. Apulsed Neodymium -YAG laser producing 100 µs pulses at a repetition rate of 10 Hz wasused to ablate human cadaver arterial tissue using approximately 500 mJ per pulse at awavelength of 1064 nm or 300 mJ at a wavelength of 1.3 pm. Both wavelengths are capableof ablating atheroma with little histological evidence of surrounding thermal damage. Craterdepths of about 5 µm per Joule were produced using 1064 nm with normal tissue exposedunder saline. Crater depth increases by about 50% when exposures are carried out underblood and when diseased arterial tissue is exposed the crater depth is almost doubled. Depthof ablation with a wavelength of 1.3 gm is 3 to 4 times greater than with 1064 nm for thesame exposure and a similar increased response is seen for diseased tissue or in the presenceof blood. Further experiments at 1064 nm have shown that the ball-tip device has advantagesover bare fibre or sapphire tipped devices in the recanalisation of occluded femoral vessels inan artificial circulation.1. INTRODUCTIONSeveral laser systems are now available for the purpose of percutaneous recanalisation ofoccluded arteries. The first to reach widespread clinical application have been the "hot tip"devices in which a metal probe is heated by a continuous wave lasers. Such devices havebeen shown to successfully recanalise peripheral vessels but may produce extensivesurrounding thermal damage or debris formation. Some clinical series have reported a highrate of early reocclusion after using such devices3 and the reported results in the coronarycirculation have been disappointing4. The use of short pulses of light has been shown to limitthe extent of thermal injury5 and the first clinical experience with pulsed lasers for angioplastyhas recently been reported6.The use of pulsed lasers may present problems in the design of suitable devices for thedelivery of the laser energy as the peak power densities produced may be very high. Bareoptical fibres are capable of transmitting the energy from many pulsed lasers but they aresharp and have been shown to cause an unacceptable rate of vessel perforation7. Various tipmodifications have been suggested8 but only some are suitable for use with a pulsed laser.Sapphire tips have been used previously for clinical angioplasty with the pulsed Nd -YAGlasers but these are difficult to couple efficiently to the laser fibre andmay become hot duringuse9.

In laser angioplasty one of the factors influencing the immediate damage (and therefore the risk of acute arterial perforation) is the optical absorption characteristics of the target tissue. In an attempt to evaluate the differences in optical absorptive properties, the transmission spectrograms of samples of normal and atheromatous human postmortem aortic wall were measured over the visible spectrum. Optical transmission varied inversely with sample thickness and directly with wavelength through both normal and atheromatous samples. Over the whole visible spectrum atheromatous tissue transmitted less per unit thickness than normal tissue. This differential effect was, however, most pronounced at 500 nm, where atheromatous tissue transmitted light 5–10 times less strongly than normal aortic wall. Such wavelength dependent differential optical absorption could provide a means for the selective photovaporisation of atheroma in laser angioplasty.

Laser angioplasty is the reopening of a blocked or narrowed vessel by the intraluminal application of laser energy.