Multiple studies have demonstrated that subgroups of patients receiving combination therapy with aspirin and clopidogrel fail to produce the anticipated antiplatelet effect, and various terms such as 'aspirin resistance', 'clopidogrel resistance', 'heightened post-treatment platelet reactivity' and 'residual platelet reactivity' have been introduced in the medical literature. Light transmittance aggregometry is generally considered to be the gold standard for determining platelet function, but its relevance to in vivo platelet function is questionable and the logistical demands of the method make it impossible to use in daily practice. The introduction of several point-of-care platelet function assays may be the key to the widespread clinical use of platelet function testing and may identify patients who are at risk for the occurrence of adverse cardiac events. In the present paper, we discuss the current commercially available methods of assaying platelet function, including their advantages and limitations and whether they have been shown to correlate with clinical outcomes.

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BackgroundSuper-responders to cardiac resynchronisation therapy (CRT) show an exceptional improvement in left ventricular ejection fraction (LVEF). Previous studies showed that apical rocking was independently associated with echocardiographic response to CRT. However, little is known about the association between apical rocking and super-response to CRT.ObjectivesTo determine the independent association of LV apical rocking with super-response to CRT in a large cohort.MethodsA cohort of 297 consecutive heart failure patients treated with primary indication for CRT-D were included in an observational registry. Apical rocking was defined as motion of the left ventricular (LV) apical myocardium perpendicular to the LV long axis. ‘Super-response’ was defined by the top quartile of LVEF response based on change from baseline to follow-up echocardiogram. Best-subset regression analysis identified predictors of LVEF super-response to CRT.ResultsApical rocking was present in 45 % of patients. Super-responders had an absolute mean LVEF increase of 27 % (LVEF 22.0 % ± 5.7 at baseline and 49.0 % ± 7.5 at follow-up). Apical rocking was significantly more common in super-responders compared with non-super-responders (76 and 34 %, P < 0.001). In univariate analysis, female gender (OR 2.39, 95 % CI 1.38–4.11), lower LVEF at baseline (OR 0.91 95 % CI 0.87–0.95), non-ischaemic aetiology (OR 4.15, 95 % CI 2.33–7.39) and apical rocking (OR 6.19, 95 % CI 3.40–11.25) were associated with super-response. In multivariate analysis, apical rocking was still strongly associated with super-response (OR 5.82, 95 % CI 2.68–12.61). Super-responders showed an excellent clinical prognosis with a very low incidence of heart failure admission, cardiac mortality and appropriate ICD therapy.ConclusionApical rocking is independently associated with super-response to CRT.Electronic supplementary materialThe online version of this article (doi:10.1007/s12471-015-0768-4) contains supplementary material, which is available to authorized users.

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Funding Acknowledgements Type of funding sources: None. Background/introduction Early studies of the Nanostim leadless pacemaker demonstrated technical feasibility effective pacing performance at the short-term. However, recently the Nanostim proved to be susceptible to early-life battery failures. Purpose In this study, we addressed the following research questions: 1) What percentage of Nanostim LPs experience early-life battery failure? 2) Is Nanostim extraction and subsequent pacemaker reimplantation safe and effective? 3) Is three monthly follow-up under the Nanostim advisory effective at preventing Nanostim LP related in-between hospitalizations? Methods In a retrospective study, we collected data of 49 Nanostim implanted patients with a mean follow up of 3 (±1.5) years at our tertiary hospital. Results Nanostim early-life battery failure in our population was 37% (18/49). Extraction of 14 Nanostim pacemakers (device age 1040  ± 467 days) in an older population (80 ± 7 years) was safe (0 complications) and effective (80% extraction success, 100% reimplantation success). All known cases of early-life battery failure were identified during the three monthly follow-up consultations. Conclusions Nanostim LP early-life battery failure is substantially higher than previously reported. In case of dysfunction Nanostim extraction in an older population is safe and effective. Three monthly follow-up is effective at preventing in-between Nanostim related hospitalization. Abstract Figure. Management of Nanostim battery failure