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Background To chart the evolution of the CTO-PCI landscape in Belgium and Luxembourg, the Belgian Working Group on Chronic Total Occlusions (BWGCTO) was established in 2016. Methods Between May 2016 and December 2019, patients undergoing a CTO-PCI treatment were prospectively and consecutively enrolled. Twenty-one centres in Belgium and one in Luxembourg participated. Individual operators had mixed levels of expertise in treating CTO lesions. Demographic, angiographic, procedural parameters and incidence of major adverse cardiac and cerebrovascular events (MACCE) were systematically registered. Results Over a four-year enrolment period, 1832 procedures were performed in 1733 patients achieving technical success in 1474 cases (80%), with an in-hospital MACCE rate of 2.3%. Fifty-nine (3%) cases were re-attempt procedures of which 41 (69%) were successful. High-volume centres treated more complex lesions (mean J-CTO score: 2.15 +/- 1.21) as compared to intermediate (mean J-CTO score: 1.72 +/- 1.23;p < 0.001) and low-volume centres (mean J-CTO score: 0.99 +/- 1.21;p = 0.002). Despite this, success rates did not differ between centres (p = 0.461). Overall success rates did not differ over time (p = 0.810). High-volume centres progressively tackled more complex CTOs while keeping success rates stable. In all centres, the most applied strategy was antegrade wire escalation (83%). High-volume centres more often successfully applied antegrade dissection and re-entry and retrograde techniques in lesions with higher complexity. Conclusion With variable experience levels, operators treated CTOs with high success and relatively few complications. Although AWE remains the most used technique, it is paramount for operators to be skilled in all contemporary techniques in order to be successful in more complex CTOs.

Purpose Heart failure (HF) is a complex syndrome. Its appropriate management should combine several health measurements. We assessed the relationship between the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Pocock’s clinical score. Methods We conducted a prospective registry of HF outpatients. The main outcome was occurrence of death or hospitalization during a 6-month follow-up. A multivariate logistic regression was performed, including the KCCQ overall summary score, the Pocock’s clinical score and their interaction in the model. Results From January 2008 to December 2010, 143 patients were involved. Mean age of patients was 68 years, and 74 % were men. KCCQ’s overall summary score and Pocock’s clinical score were inversely correlated (r = −0.24, p = 0.026). A total of 61 (42.7 %) events occurred. There was a high proportion of events (77.8 %) in patients with a Pocock’s clinical score >50 %, whatever the KCCQ score value. When the KCCQ score was ≤50 %, there was a low increase in risk as the Pocock’s clinical score increased (OR 2.0 [0.6; 6.6]). However, when the KCCQ score was between 50 and 75 or ≥75 %, there was a high increase in risk as the Pocock’s clinical score increased (OR 6.9 [1.2; 38.9] and OR 7.4 [0.8; 69.7], respectively). Conclusions Patients with a high Pocock’s clinical score are at a high risk of death or hospitalization. For patients with a low Pocock’s clinical score, the KCCQ score can identify those at risk of these events. Electronic supplementary material The online version of this article (doi:10.1007/s11136-015-1154-9) contains supplementary material, which is available to authorized users.

The MEDCOR trial is a double-blind, randomized study aiming at demonstrating the superiority of molsidomine (direct NO donor) over placebo, used as add-on treatments, on improving endothelial function (EF) after 12 months, in stable angina patients undergoing percutaneous coronary intervention.EF was assessed by peripheral vasodilator response (i.e. Endoscore) using arterial tonometry and by several biomarkers, in terms of changes versus baseline after a one-year treatment.The change in Endoscore was +75 ± 130% in placebo group and +39 ± 145% in molsidomine group (p = 0.143). There was a decrease in sICAM-1 with molsidomine (-6%) and an increase with placebo (+6%). The MPO activity/antigen ratio slightly increased with placebo (+9%) and strongly decreased with molsidomine (-42%) (p = 0.020).The MEDCOR trial was not able to demonstrate significant differences between molsidomine and placebo for all parameters, except the MPO activity/antigen ratio which significantly decreased with molsidomine (p = 0.020 versus placebo).

The effects of molsidomine (a direct nitric oxide donor) on the endothelial dysfunction have never been evaluated using reactive hyperemia peripheral arterial tonometry (RH-PAT). The objective of the MEDCOR double-blind trial will be to demonstrate the superiority of molsidomine (Coruno® 16 mg, once daily) over placebo, on improving the endothelial function (Endoscore by RH-PAT) after 12 months of treatment in stable angina patients undergoing elective percutaneous coronary intervention (PCI). Study design will take care of the real-life situation, in which patients are being offered PCI and stent placement (drug-eluting or bare metal), but also gold standard medical therapy (beta-blockers, statins, angiotensin-converting enzyme inhibitors (ACEIs), and/or calcium antagonists). Demonstrating clinical and statistical superiority of the study drug over placebo will be a real challenge. Therefore, a sequential approach has been designed with a pilot phase aiming at recruiting 50 patients. Upon evaluation of the results by an independent data steering committee, a larger sample size phase will eventually be considered.

We reflect on the nature of digital telecommunication systems. We argue that these systems require, by nature, a heterogeneous specification and an implementation with heterogeneous architectural styles. CoWare is a hardware/software co-design environment based on a data model that allows to specify, simulate, and synthesize heterogeneous hardware/software architectures from a heterogeneous specification. CoWare is based on the principle of encapsulation of existing hardware and software compilers and special attention is paid to the interactive synthesis of hardware/software and hardware/hardware interfaces. The principles of CoWare are illustrated by the design process of a spread-spectrum receiver for a pager system.

Embedded system architectures comprising of software programmable components (e.g. DSP, ASIP, and micro-controller cores) and customized hardware co-processors, integrated into a single cost-efficient VLSI chip, are emerging as a key solution to today's microelectronics design problems. This trend is being driven by new emerging applications in the areas of wireless communication, high-speed optical networking, and multimedia computing, fueled by increasing levels of integration. These applications are often subject to stringent requirements in terms of processing performance, power dissipation, and flexibility. A key problem confronted by embedded system designers today is the rapid prototyping of an application-specific embedded system architecture where different combinations of programmable processor components, library hardware components, and customized hardware components must be integrated together, while ensuring that the hardware and software parts communicate correctly. Designers often spend an enormous time on this highly error proned task. In this paper, we present a solution to this embedded architecture co-synthesis and system integration problem based on an orchestrated combination of architectural strategies, parameterized libraries, and software CAD tools.

AIMS Transcriptome patterns associated with acute myocardial infarction at the site of coronary occlusion are largely unknown. The aim of this study was to decipher the angiogenic, atherosclerotic, and inflammatory mRNA profiles in whole blood samples collected at the site of coronary occlusion in patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS In five consecutive patients with STEMI, blood was sampled at the site of occlusion (local) and in the systemic circulation (peripheral) during primary percutaneous coronary intervention. RNA was extracted from whole blood samples. Among 221 genes involved in angiogenesis, inflammation and atherosclerosis, 24 were shown to be differentially modulated locally, by analysis with custom-designed DNA array technology. Validation in 28 distinct STEMI patients using real-time quantitative PCR identified seven out of these 24 genes to be consistently and significantly upregulated in local versus peripheral blood (p

Bone marrow (BM) cells may interact with coronary endothelium and modulate coronary atherosclerosis. We investigated the time course of coronary luminal loss and changes in conductance after intracoronary injection of enriched hematopoietic BM stem cells in patients with previous myocardial infarction (MI). Among 24 patients with acute MI, 13 were randomized to early (

Cocaine is an increasing cause of admission in the emergency room. The widespread abuse of this drug during the last decade in the USA is now widely emerging in Europe. Because of its various cardio-vascular complications, cocaine is one of the most death-related drugs known at this time. The following report describes the dramatic case of a young man polydrug addict presenting at our institution with life-threatening acute heart failure that developed shortly after his very first cocaine intake. Because of the lack of response to intensive medical treatment, we decided to perform a percutaneous extracorporeal circulation membranous oxygenation (ECMO) that allowed survival and rapid left ventricular function recovery. This report highlights cocaine as a rising trigger of acute heart failure in young people and is, to the best of our knowledge, the first report that illustrates ECMO as an effective hemodynamic support in the course of fulminant cocaine-induced cardiomyopathy.

Deep sub-micron processing technologies have enabled the implementation of new application-specific embedded architectures that integrate multiple software programmable processors (e.g. DSPs, microcontrollers) and dedicated hardware components together onto a single cost-efficient IC. These application-specific architectures are emerging as a key design solution to today's microelectronics design problems, which are being driven by emerging applications in the areas of wireless communication, broadband networking, and multimedia computing. However the construction of these customized heterogeneous multiprocessor architectures, while ensuring that the hardware and software parts communicate correctly, is a tremendously difficult and highly error proned task with little or no tool support. In this paper, we present a solution to this embedded architecture co-synthesis problem based on an orchestrated combination of architectural strategies, parameterized libraries, and software tool support.

Syntax directed translation based compilation from high-level concurrent programs has matured significantly over the past few years. They have been applied to significant designs in the domains of digital signal processing and microprocessor designs. For data-path dominated designs, like those found in digital signal processing applications, syntax directed translation approaches have been shown to generate efficient asynchronous implementations. However for control-dominated designs where the data processing parts play a relatively minor role, we believe the solutions produced by pure syntax directed translation methods may be significantly improved. In this paper we consider the problem of resynthesizing the control parts of the syntax directed translation solutions by means of STG based algorithmic synthesis approaches. This involves a strategy for partitioning between the control and data processing parts, algorithms for reconstructing the STGs from the control partitions, and a strategy for resynthesizing these reconstructed STGs using existing STG-based synthesis approaches. We show with a realistic design experiment that our control resynthesis approach can offer significant improvements over pure syntax directed translation solutions.

This paper presents an orchestrated combination of software synthesis and automatic hardware/software interface generation to meet hard real-time constraints. The target applications are digital communication systems, which are specified as concurrent communicating processes. The overall approach is theoretically founded and is demonstrated on an industrial strength design, with promising results.

Digital signal processing (DSP) systems perform real-time transformations on time discrete digitised samples of analogue quantities with finite band-width and signal to noise ratio. These transformations can be specified in programming languages and executed on a programmable processor or directly on application specific hardware. The choice is determined by trade-offs between cost, performance, power and flexibility. Hence DSP is a candidate par excellence for hardware-software co-design.

Heterogeneous embedded multiprocessor architectures are becoming more prominent as a key design solution to today's microelectronics design problems. These application-specific architectures integrate multiple software programmable processors and dedicated hardware components together on to a single cost-efficient IC. In contrast to general-purpose computer systems, embedded systems are designed and optimized to provide specific functionality, using possibly a combination of different classes of processors (e.g. DSPs, microcontrollers) from different vendors. While these customized heterogeneous multiprocessor architectures offer designers new possibilities to trade off programmability, processing performance, power dissipation, and design turnaround time, there is currently a lack of tools to support the programming of these architectures. In this paper, we consider the problem of providing real-time kernel support for managing the concurrent software tasks that are distributed over a set of processors in an application-specific multiprocessor architecture. This is complementary to current research activities that aim to provide efficient retargetable code generation for a broad range of embedded processors.

Stenting with biodegradable stents is a new interventional approach aimed at adaptive coronary remodelling by limiting acute elastic recoil and late neointimal proliferation. Here, we report on a 53-year-old patient presenting with stable angina and treated with a biodegradable magnesium-alloy stent (Magic, Biotronic Bulach, Switzerland) in the left coronary circumflex artery (LCx). Magnesium alloy offers the benefit of mechanical properties comparable with conventional stents combined with controlled absorption over time. In our patient, two magnesium-alloy stents were implanted in the proximal to mid-part of the LCx. The procedure was complicated by acute dissection distal from both stents, which was treated medically. At 4 months’ follow-up, LCx was patent, minimal luminal diameter in the stented segment was 1.35 mm (panel A, top). At intravascular ultrasound, residues of magnesium alloys were noted. Note, a minimal cross-sectional area was 3.4 mm2, a value below the ischaemic threshold (panel B, top row). Consistent with the segment morphology, functional intracoronary evaluation showed significantly reduced fractional flow reserve of 0.68 (panel A, top). At 8 months’ follow-up, neither residues of the magnesium alloy nor neointimal proliferation were noted. A positive coronary remodelling was shown from an increase in the minimal cross-sectional area and minimal luminal diameter at both angiography (panel A, bottom) and intravascular ultrasound (panel B, bottom row). In addition, this was paralleled by a significant increase of fractional reserve up to 0.85, a value above the ischaemic threshold. These observations demonstrate late adaptive remodelling of the atherosclerotic coronary artery following the resolution of a biodegradable stent. Figure 1 (A) Coronary angiograms after percutaneous coronary intervention with a biodegradable stent. An angiogram at 4 months’ follow-up was taken in a right anterior oblique (RAO) view 31°, caudal 30° (left panel) and at 8 months follow-up ... Figure 2

Embedded system architectures comprising of software programmable components (e.g. DSP, ASIP, and micro-controller cores) and customized hardware co-processors, integrated into a single cost-efficient VLSI chip, are emerging as a key solution to today's microelectronics design problems. This trend is being driven by new emerging applications in the areas of wireless communication, high-speed optical networking, and multimedia computing, fueled by increasing levels of integration. These applications are often subject to stringent requirements in terms of processing performance, power dissipation, and flexibility. A key problem confronted by embedded system designers today is the rapid prototyping of an application-specific embedded system architecture where different combinations of programmable processor components, library hardware components, and customized hardware components must be integrated together, while ensuring that the hardware and software parts communicate correctly. Designers often spend an enormous time on this highly error proned task. In this paper, we present a solution to this embedded architecture co-synthesis and system integration problem based on an orchestrated combination of architectural strategies, parameterized libraries, and software CAD tools.