The Netherlands Trial Register #NTR166 (www.trialregister.nl) and the International Standard Randomised Controlled Trial, #ISRCTN95796863 (http://isrctn.org).

In a setting close to 'real world' practice, this multicentric study confirms the feasibility and reliability of thermodilution-derived CFR. In addition, the safety and the swiftness of assessing FFR and CFR with one single guide wire makes the latter a unique clinical tool for the evaluation of the coronary circulation.

Background: Sedentary behaviour (SB) is potentially an important target to improve cardiovascular health. This study 1) compared SB between cardiovascular disease (CVD) patients and age-matched controls, 2) identified characteristics associated with high SB levels, and 3) determined the impact of contemporary cardiac rehabilitation (CR) on SB. Methods: For objective 1, we recruited 131 CVD patients and 117 controls. All participants were asked about their general characteristics and medical history. SB was assessed by an objective accelerometer (activPAL3 micro). For objective 2, 2584 CVD patients were asked to fill in a questionnaire about their general characteristics, lifestyle, medical history and their SB. For objective 3, 131 CVD patients were followed over time and measured, pre-, directly post-and 2 months post-CR. Results: Objective 1. CVD patients spent 10.4 h/day (Q25 9.5; Q75 11.2) sedentary which was higher compared to healthy controls (9.4 h/day [Q25 8.4; Q75 10.29]). Objective 2. CVD patients being male, single or divorced, employed, physically inactive, reporting high alcohol consumption, living in an urban environment, having comorbidities and cardiac anxiety demonstrated a greater odds for large amounts of SB. Objective 3. The CR program significantly reduced sedentary time (−0.4 h/day [95%CI-0.7; −0.1]), which remained lower at 2-months post-CR (−0.3 h/day [95%CI-0.6; −0.03]). Conclusions: CVD patients had greater amounts of objectively measured sedentary time compared to healthy controls. Sedentarism was associated with personal-and lifestyle characteristics, and comorbidities. Participation in a contemporary CR program slightly reduced sedentary time, but tailored interventions are needed to target SB in CVD patients.

Background Intensive lipid lowering may retard the pro gression of coronary atherosclerosis. LDL-apheresis has the potential to decrease LD L cholesterol to very low levels. To assess the effect of more aggressive lipid lowering with LDLapheresis, we set up a randomized study in men with hyper cholesterolemia and severe coronary atherosclerosis.Methods and Results For 2 years, 42 men were treated with either biweekly LDL-apheresis plus medication or medication alone. In both groups a dose of simvastatin of 40 mg per day was administered. Baseline (m ean±SD) LDL cholesterol was 7.8 ±1.9 mmol -L l and 7.9±2.3 mmol * L~! in the apheresis and medica tion groups, respectively. The mean reduction in LDL cholesterol was 63% (to 3.0 mmol * L" 1) and 47% (to 4.1 mmol • L_l), respectively. Primary quantitative coronary angiographic end points were changes in average mean segment diameter and minimal obstruction diameter. No differences between the apheresis and medication groups were found in mean segment diameter (-0.01 ±0.16 mm versus 0.03 ±0.16 mm, respectively)

The intrinsic limitations of coronary arteriography to predict the physiological effects of coronary obstructions are well known. Therefore, more direct assessments of the functional significance of coronary stenoses are becoming increasingly important. Study of contrast passage by electrocardiogram-triggered digital radiography has been proposed as a way of assessing changes in myocardial perfusion. The main problems in this approach are the limited time for motionless image acquisition, the potential alteration of vascular volume between different states, and the changing flow pattern induced by contrast agents. This has led to empiric substitution of mean transit time (Tmn) by other time parameters and to representation of vascular volume by maximal contrast intensity (D..). To avoid these problems, intact dogs were studied during almost motionless image acquisition of 20-25 consecutive paced heart beats obtained with synchronous radiographic pulses. In (weight, 26-36 kg) were anesthetized with sodium pentobarbital 25 mg/kg i.v., a left thoracotomy was performed, and epicardial pacing electrodes were sutured on the left atrium. The proximal part of the left circumflex artery (LCx) was gently dissected free, over a distance of 1.0-1.5 cm proximal of the origin of the first large obtuse marginal branch. A ring-mounted 20-MHz pulsed Doppler probe (Crystal Biotech Inc., Holliston, Massachusetts) was placed around the artery and a circular balloon occluder (R.E. Jones, Silver Springs, Maryland) was placed just distal to the Doppler probe. The pericardium and chest were closed, and the instrumentation leads were placed in a subcutaneous pocket until the time of study.At day 11 after instrumentation, each dog was anesthetized by nicomorphine 10 mg/hr i.v. and ethrane. The subcutaneous pocket was opened, and the wires of the Doppler probe were connected to the appropriate recording equipment (545C-4 Directional Pulsed Doppler Flowmeter, Department of Bioengineering, University of Iowa, Iowa City, Iowa). The pacing electrodes were attached to a trigger unit (Department of Bioengineering, University of Nijmegen, The Netherlands) and the occluder tube was connected to a 5-ml syringe. Both femoral arteries were dissected free. An 8F pigtail manometer catheter (Millar microtipped-catheter transducer SPC-780C) was introduced into the left femoral artery and positioned for simultaneous pressure recording in the left ventricle and the ascending aorta. A 5F left Judkins catheter was introduced into the right femoral artery and advanced into the ostium of the left main coronary artery. Electrocardiogram, left ventricular pressure and its first derivative, aortic pressure, and phasic and mean coronary blood flow velocity in the LCx were recorded on an eightchannel recorder (Hewlett-Packard).After intravenous infusion of 5 mg propranolol during 20 minutes to prevent disproportionate increase in heart rate, an initial dose of dipyridamole (0.75 mg/kg) was administered intravenously during 4 minutes to create maximal dilation ...