SummaryBackground Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest antiischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach. We aimed to investigate the safety and efficacy of early de-escalation of antiplatelet treatment from prasugrel to clopidogrel guided by platelet function testing (PFT).

Background We investigated whether the combination of multimodal behaviour therapy (BT) with fluvoxamine is superior to BTand placebo in the acute treatment of severely ill in-patients with obsessive-compulsive disorder (OCD).Method In a randomised, double-blind design, 30 patients were treated for nine weeks with BT plus placebo and 30 patients with BT plus fluvoxamine (maximum dosage 300 mg, mean dose 288.1 mg). BT included exposure with response prevention, cognitive restructuring and development of alternative behaviours.Results Both groups showed a highly significant symptom reduction after treatment. There were no significant differences between the groups concerning compulsions. Obsessions were significantly more reduced in the fluvoxamine and BT group than in the placebo and BT group. Furthermore, the group BT plus fluvoxamine showed a significantly higher response rate (87.5 v. 60%) according to a previously defined response criterion. Severely depressed patients with OCD receiving BT plus placebo presented a significantly worse treatment outcome (Y–BOCS scores) than all other groups.Conclusions The results suggest that BTshould be combined with fluvoxamine when obsessions dominate the clinical picture and when a secondary depression is present.

As a luminogram, coronary angiography provides a good overview of the coronary artery tree. Using quantitative coronary measurements, the degree of coronary obstruction can be determined. The limitation of coronary angiography is that it does not provide information on the arterial wall structure and therefore cannot assess the extent of atherosclerosis. Knowledge about adaptive coronary remodelling processes as compensatory enlargement of the coronary artery has focused diagnostic interest on the non-stenotic lesions of the coronary tree. Intravascular ultrasound (IVUS) can reveal discrepancies between the extent of coronary atherosclerosis and angiography imaging by in vivo plaque imaging. Spectrum analysis of IVUS-derived radiofrequency (RF) data enables a more detailed analysis of plaque composition and morphology. Preliminary in vitro studies correlated four histological plaque components with a specific spectrum analysis of the RF data. The different components (fibrous, fibrofatty, necrotic core and dense calcium) are colour coded. Coronary tissue maps were reconstructed from RF data using IVUS-Virtual Histology (VH IVUS) software (Real-Time VH, Volcano Corporation, Rancho Cordova, California, USA). VH IVUS has the potential to detect high-risk lesions and can provide new insights into the pathophysiology of coronary artery disease. VH IVUS allows the differentiation of different lesion types based on information derived from histopathology. The in vivo specific histological analysis of coronary atherosclerosis may allow better stratification of treatment of patients with coronary artery disease.

Sixty-four slice MDCT angiography failed to predict the functional relevance of CAS, but had a high negative predictive value in the exclusion of functionally relevant CAS in symptomatic patients.

Objective Intravascular ultrasound (IVUS) is a diagnostic imaging technique for tomographic visualization of coronary arteries. Automatic analysis of IVUS images is difficult due to speckle noise, artifacts of the catheter, and shadows generated by calcifications. We designed and implemented a system for automated segmentation of coronary artery IVUS images. Methods Two methods for automatic detection of the intima and the media-adventitia borders in IVUS coronary artery images were developed and compared. The first method uses the parametric deformable models, while the second method is based on the geometric deformable models. The initial locations of the borders are approximated using two different edge detection methods. The final borders are then defined using the two deformable models. Finally, the calcified regions between the extracted borders are identified using a Bayesian classifier. The performance of the proposed methods was evaluated using 60 different IVUS images obtained from 7 patients. Results Segmented images were compared with manually outlined contours. We compared the performance of calcified region characterization methods using ROC analysis and