ABSTRACTS
Sessions
Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NWC)
Session 1, Friday 27 October 2006
26-28 October 2006, De Heerlickheid, Ermelo Adult Congenital Heart Disease Voorzitters H.W. Viiegen en F.J. Meijboom
11.00 - 11.15 uur
IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION: THE EFFECT OF RIGHT VENTRICULAR PRESSURE OVERLOAD ON REPOLARIZATION PARAMETERS IN THE STRUCTURALLY NORMAL HEART I.R. Henkenso, A. Vonk Noordegraaf2 A. Boonstra2, R. Scherptong', C.A. Swennel, A.C. Maan', 0. Kamp E.E. v.d. Wall', M.J. Schalij', H.W. Vllegen'. 1=Department of Cardiology, Leiden University Medical Center, 2=Department of Pulmonology, VU Medical Center, 3=Department of Cardiology, VU Medical Center.
11.15 - 11.30 uur
Adult Congenital Heart Disease Voorzitters H.W. Viiegen en F.]. Meijboom
AGE IS A PREDICTOR FOR PULMONARY ARTERIAL HYPERTENSION IN ADULT PATIENTS WITH A CARDIAC SEPTAL DEFECT EE Padmos MG] Duffels' PM Engelfriet', BJ Bouma', RMF Berger 2, BJM Mulder"3. Department of Cardiology, Academic Medical Center", Amsterdam, University Medical Center Utrechte, Department of Paediatric Cardiology, University Medical Center Groningen2. Purpose: This study was designed to determine predictors for pulmonary arterial hypertension (PAH) among adult patients with a cardiac septal defect.
Background: Diagnosis of Pulmonary Arterial Hypertension (PAH) Is a devastating disease characterized by progressive right heart failure, eventually leading to death. Right ventricular (RV) hypertrophy is present according to RV workload. Hypothesis: The pathologically increased workload of the RV In PAH patients associated with RV hypertrophy will induce significant changes in electrocardiographic (ECG) repolarization parameters.
Methods: A cross sectional study of adult patients with a cardiac septal defect currently under follow-up in the AMC. Gender, age, type of septal defect, age at repair and PAH were recorded. PAH was defined as a systolic pulmonary arterial pressure (sPAP) above 40 mmHg, estimated by means of Dopplerechocardlographlcal
Methods: Idiopathic PAH is a diagnosis per exclusionem, established by stepwise elimination of possible causes of pulmonary hypertension. A cohort of 25 patients diagnosed with idiopathic PAH was selected for analysis of ECG parameters. A digital ECG made within 30 days of catheterization was available in all patients. Patient ECGs were compared to ECGs from healthy controls from a large ECG database, matched for sex and QRS duration. ECGs were analyzed with dedicated software, rendering vectorcardiographical parameters besides standard scalar parameters. Parameters chosen were: Twave area in vector magnitude (area I point-T apex + area T apexglobal end of T in pV*ms), QRS-T spatial angle', and ventricular gradient magnitude (mV*ms).
Results: One hundred seventy-three patients (95 VSD, 45 ASDII, 17 ASDI and 16 AVSD) were Identified. In 93 patients, the defect was closed. Prevalence of PAH among adult patients with a cardiac septal defect was 12% overall (9% In closed defects and 15% in open defects). Of these patients, 2% had the Elsenmenger syndrome. Median age of the patients was 32 years (range 19-78 years, 41% male). Highest prevalence of PAH was found in ASD g, both in closed and open defects (14 and 33%, resp.) Increasing age was associated with development of PAH (Odds ratio=1.05 per year, p 50% STsegment resolution early after successful rescue PCI would be associated with a lower final infarct size and Improved clinical outcome. Methods: Between 2001 and 2005 we studied 108 consecutive STEMI patients who underwent successful rescue PCI (TIMI 3 flow on post PCI angiography) after FT. Outcome measures were the Selvester score for final infarct size (based on QRS-complex features analyzed on discharge electrocardiogram) and the combined endpoint of mortality and cardlogenic shock.
Results: Of the studied patients 6304 (n=68) had > 50% STsegment resolution, whereas 37°/O (n=40) did not. Baseline characteristics like age, medical history, infarct localization and time to treatment did not differ. The median time from angiography to post-PCI ECG was 1:42h (IQR 1:08 - 2:20). The Selvester score was lower In patients with > 50YO ST-segment resolution, but not significantly: 5.45 vs. 6.57 points (p=0.08). Also the rate of mortality and cardiogenic shock tended to be lower in patients with > 50% STsegment resolution: 4% (n=3) vs. 130o (n=5; p=0.14) respectively.
Conclusion: After successful rescue PCI > 50° ST-segment resolution is still observed in 63% of patients and seems associated with a lower final infarct size and improved outcome. These results suggest that myocardial salvage may be the mechanism of benefit in rescue PCI.
Heart Faliure/Dyssynchrony/CRT Voorzltters 0. Kamp en MJ.jM. Cramer
11.00 - 11.15 uur
PHASE ANALYSIS OF GATED MYOCARDIAL PERFUSION SPECT COMPARED TO TISSUE DOPPLER IMAGING FOR THE ASSESSMENT OF LEFT VENTRICULAR DYSSYNCHRONY MM Hlenneman, J Chen, C Ypenburg, P Dibbets, GB Bleeker, E Boersma, MP Stokkel, EE van der Wall, EV Garcia, JJ Bax. Leiden University Medical Center, Emory University School of Medicine, Erasmus University Rotterdam.
Purpose: It has been suggested that LV dyssynchrony is an important predictor of response to cardiac resynchronization therapy (CRT); dyssynchrony is predominantly assessed by TDI with echocardiography. Information on LV dyssynchrony can also be provided by gated myocardial perfusion SPECT (GMPS) with phase analysis of regional LV maximal count changes throughout the cardiac cycle which tracks the onset of LV thickening. Purpose of this study was to compare LV dyssynchrony assessment by GMPS and TDI. Methods: In 75 patients with heart failure, depressed LV function and wide QRS complex, GMPS and 2D echocardiography, including TDI, were performed as part of clinical screening for eligibility for CRT. Different parameters (histogram bandwidth, phase standard deviation (SD), histogram skewness and histogram kurtosis) of LV dyssynchrony were assessed from GMPS and compared with LV dyssynchrony on TDI using Pearson's correlation analyses.
Results: Histogram bandwidth and phase SD correlated well with LV dyssynchrony assessed with TDI (r=0.89, P23) R eQ Irv(n-6A7)
10% Good
cerebral function
Moderate
Severe
Vegetative
disability
disabibty
state
Brain death
Electrophysiology Voorzitters Mw. I.C. van Gelder en L.V.A. Boersma
10.15 - 10.30 uur
ATRIAL PACING TO PREVENT PAROXYSMAL ATRIAL FIBRILLATION IN PATIENTS WITHOUT BRADYCARDIA - A RANDOMIZED TRIAL M.E.W. Hemels, J.H. Ruiter2, G.P. Molhoek3, N.J.G.M. Veegerl, D.E.P. De Waard4, R. Van Mechelens, L.H. Savalle6, A.C.P. Wiesfeld', C.J.H.J. Kirchhof7, R. Kessels8, H. Robbe8, I.C. Van Gelderl. 'University Medical Center Groningen, Groningen, 2Medical Center Alkmaar, Alkmaar, 3Medisch Spectrum Twente, Enschede, 4Antonius Hospital, Sneek, 5Sint Fransiscus Gasthuis, Rotterdam, 6Medical Center Haaglanden, Den Haag, 7Rijnlaand Hospital, Leiderdorp, 8Medtronic Bakken Research Center,
Maastricht. Purpose: The Features in AT500rm study; Chances for patients with Episodes of atnal Tachyarrhythmia without bradycardia indication for pacing (FACET), was a prospective, randomized, multicenter, cross-over pilot study to evaluate the efficacy of preventive pacing and antitachycardia pacing (ATP) in patients with symptomatic paroxysmal atrial fibrillation (AF).
Methods: A total of 52 patients with symptomatic paroxysmal AF who failed on at least two different anti-arrhythmic drugs and without bradyarrhythmias were induded. Thirty-eight patients were randomized after a 4 weeks monitor phase post-implant of a DDDRP pacemaker (ATS00, Medtronic Inc., Minneapolis) to prevention and ATP therapies ON or OFF during 12 weeks in each treatment phase with a 4 weeks wash-out phase in between. In the ON phase the lower rate was set on AAI 70 ppm versus MI 34 ppm backup pacing in the monitor, wash out, and OFF phase. The atrial lead was preferably placed in the interatrial septum. Primary endpoint was AF burden.
Results: Mean age of the thirty-eight randomized patients was 6219 years, 53% male, history of mild hypertension 26%, 71% lone AF. Median number of AF episodes during the last 3 months before inclusion was 24 (3-270), median duration was 2.5 hours (0.2-24.0). Septal lead placement was achieved in 68% of patients and in 79% of patients additional class I or III antiarrhythmic drugs were used (stable regime). During treatment there was a trend for AF burden reduction compared to the OFF phase, median AF burden (interquartile range) 2.4% (0.2-12.2) versus 3.3% (1.0-15.2), respectively, p=0.06. In the subgroup of 26 patients with septal lead placement, the reduction of AF burden was significant, median AF burden (interquartile range) 1.4% (0.2-8.4) versus 2.5% (1.0-8.0), respectively, p=0.03. Median efficacy of ATP during active treatment phase was 57±30%. Conclusions: In patients with AF without bradycardia, a hybrid therapy of atrial pacing with atrial prevention and ATP features and antiarrhythmic drugs reduced but not abolished AF, especially if atrial septal pacing could be accomplished.
Abstracts
Sessions Session III, Saturday 28 October 2006 Session IV, Saturday 28 October 2006 Electrophysiology
10.30 - 10.45 uur
Voorzitters Mw. I.C. van Gelder en L.V.A. Boersma
Electrophysiology Voorzitters Mw. I.C. van Gelder en L.V.A. Boersma
10.45 - 11.00 uur
INTENSIVE CHOLESTEROL LOWERING IN COUMARIN-TREATED ELDERLY PATIENTS WITH ATRIAL FIBRILLATION SHIFTS THE A ANTI BALANCE TO MORE THRONBOTICSTATE lanet T van Kuilenburg; Waander van Heerde2; Izabela Plesiewiczl; Paul Lap2; Gheorghe A Pop', Freek W Verheugt1, 'Heart Center Radboud UMCN, Nijmegen, The Netherlands 2Central Laboratory of Haematology Radboud UMCN Nijmegen, the Netherlands.
ATRIAL FIBRILLATION RECURRENCE AFTER CLASSIC MAZE III SURGERY IS RELATED TO INCOMPLETE PULMONARY VEIN TO ABLATION TREATMENT ISOLATION AMENABLE Muchtiar Khan*.MD; Fred H.M. WittkampfA, PhD; Eric F.D. Wever*,MD,PhD; Lucas V.A. Boersman,MD,PhD. *St. Antonius 3435 CM, AAZU, Hospital, Koekoekslaanl, Nieuwegein; Heidelberglaan 100, 3584 CX, Utrecht.
Purpose: In elderly patients with atrial fibrillation (AF) (silent) Ischemic brain infarcts occur despite adequate oral anticoagulation (OAC) therapy. Inflammation and thrombosis are closely related and anti-inflammatory therapy with statins and ezetemibe reduce atherothrombotic events. Our purpose is to examine if this antiinflammatory therapy has an additional effects on the thrombotic proces in patients with. AF with adequate OAC.
Purpose: Maze III surgery for lone paroxysmal atrial fibrillation (AF) shows freedom of arrhythmias In over 80% of patlents. The mechanisms of late recurrences of AF are unclear.
Methods: In 33 elderly AF patients (69-81 years old) without manifest coronary disease or diabetes and with total cholesterol between 4,5 and 7 mmol/l, placebo or atorvastatin 40 mg and ezetemibe 10 mg were given beside OAC therapy (INR 2-3) during 9 months in a randomized double-blind fashion. Cholesterol profile and hsCRP in blood were closely monitored. To investigate coagulation and fibrinolytic activity the Nijmegen Hemostasis assay was used. Prothrombin Activation Fragment (Enzygnost F1+2) analysis was performed to determine in-vivo clotting activity.
Results: F1+2 levels were not significantly different in both groups. However, in the treatment group (n=13) Endogenous Thrombin Potential (ETP) decreased significantly (p=0.002) and Plasmin Peak Height (PPH) showed higher levels (p=0.001); in the placebo group (n=17) no significant changes occurred during follow-up. Whereas mean total cholesterol and hsCRP levels reached a plateau after 3 months, coagulation markers continued to decrease significantly up to 9 months (p
Sessions
Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NWC)
Session 1, Friday 27 October 2006
26-28 October 2006, De Heerlickheid, Ermelo Adult Congenital Heart Disease Voorzitters H.W. Viiegen en F.J. Meijboom
11.00 - 11.15 uur
IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION: THE EFFECT OF RIGHT VENTRICULAR PRESSURE OVERLOAD ON REPOLARIZATION PARAMETERS IN THE STRUCTURALLY NORMAL HEART I.R. Henkenso, A. Vonk Noordegraaf2 A. Boonstra2, R. Scherptong', C.A. Swennel, A.C. Maan', 0. Kamp E.E. v.d. Wall', M.J. Schalij', H.W. Vllegen'. 1=Department of Cardiology, Leiden University Medical Center, 2=Department of Pulmonology, VU Medical Center, 3=Department of Cardiology, VU Medical Center.
11.15 - 11.30 uur
Adult Congenital Heart Disease Voorzitters H.W. Viiegen en F.]. Meijboom
AGE IS A PREDICTOR FOR PULMONARY ARTERIAL HYPERTENSION IN ADULT PATIENTS WITH A CARDIAC SEPTAL DEFECT EE Padmos MG] Duffels' PM Engelfriet', BJ Bouma', RMF Berger 2, BJM Mulder"3. Department of Cardiology, Academic Medical Center", Amsterdam, University Medical Center Utrechte, Department of Paediatric Cardiology, University Medical Center Groningen2. Purpose: This study was designed to determine predictors for pulmonary arterial hypertension (PAH) among adult patients with a cardiac septal defect.
Background: Diagnosis of Pulmonary Arterial Hypertension (PAH) Is a devastating disease characterized by progressive right heart failure, eventually leading to death. Right ventricular (RV) hypertrophy is present according to RV workload. Hypothesis: The pathologically increased workload of the RV In PAH patients associated with RV hypertrophy will induce significant changes in electrocardiographic (ECG) repolarization parameters.
Methods: A cross sectional study of adult patients with a cardiac septal defect currently under follow-up in the AMC. Gender, age, type of septal defect, age at repair and PAH were recorded. PAH was defined as a systolic pulmonary arterial pressure (sPAP) above 40 mmHg, estimated by means of Dopplerechocardlographlcal
Methods: Idiopathic PAH is a diagnosis per exclusionem, established by stepwise elimination of possible causes of pulmonary hypertension. A cohort of 25 patients diagnosed with idiopathic PAH was selected for analysis of ECG parameters. A digital ECG made within 30 days of catheterization was available in all patients. Patient ECGs were compared to ECGs from healthy controls from a large ECG database, matched for sex and QRS duration. ECGs were analyzed with dedicated software, rendering vectorcardiographical parameters besides standard scalar parameters. Parameters chosen were: Twave area in vector magnitude (area I point-T apex + area T apexglobal end of T in pV*ms), QRS-T spatial angle', and ventricular gradient magnitude (mV*ms).
Results: One hundred seventy-three patients (95 VSD, 45 ASDII, 17 ASDI and 16 AVSD) were Identified. In 93 patients, the defect was closed. Prevalence of PAH among adult patients with a cardiac septal defect was 12% overall (9% In closed defects and 15% in open defects). Of these patients, 2% had the Elsenmenger syndrome. Median age of the patients was 32 years (range 19-78 years, 41% male). Highest prevalence of PAH was found in ASD g, both in closed and open defects (14 and 33%, resp.) Increasing age was associated with development of PAH (Odds ratio=1.05 per year, p 50% STsegment resolution early after successful rescue PCI would be associated with a lower final infarct size and Improved clinical outcome. Methods: Between 2001 and 2005 we studied 108 consecutive STEMI patients who underwent successful rescue PCI (TIMI 3 flow on post PCI angiography) after FT. Outcome measures were the Selvester score for final infarct size (based on QRS-complex features analyzed on discharge electrocardiogram) and the combined endpoint of mortality and cardlogenic shock.
Results: Of the studied patients 6304 (n=68) had > 50% STsegment resolution, whereas 37°/O (n=40) did not. Baseline characteristics like age, medical history, infarct localization and time to treatment did not differ. The median time from angiography to post-PCI ECG was 1:42h (IQR 1:08 - 2:20). The Selvester score was lower In patients with > 50YO ST-segment resolution, but not significantly: 5.45 vs. 6.57 points (p=0.08). Also the rate of mortality and cardiogenic shock tended to be lower in patients with > 50% STsegment resolution: 4% (n=3) vs. 130o (n=5; p=0.14) respectively.
Conclusion: After successful rescue PCI > 50° ST-segment resolution is still observed in 63% of patients and seems associated with a lower final infarct size and improved outcome. These results suggest that myocardial salvage may be the mechanism of benefit in rescue PCI.
Heart Faliure/Dyssynchrony/CRT Voorzltters 0. Kamp en MJ.jM. Cramer
11.00 - 11.15 uur
PHASE ANALYSIS OF GATED MYOCARDIAL PERFUSION SPECT COMPARED TO TISSUE DOPPLER IMAGING FOR THE ASSESSMENT OF LEFT VENTRICULAR DYSSYNCHRONY MM Hlenneman, J Chen, C Ypenburg, P Dibbets, GB Bleeker, E Boersma, MP Stokkel, EE van der Wall, EV Garcia, JJ Bax. Leiden University Medical Center, Emory University School of Medicine, Erasmus University Rotterdam.
Purpose: It has been suggested that LV dyssynchrony is an important predictor of response to cardiac resynchronization therapy (CRT); dyssynchrony is predominantly assessed by TDI with echocardiography. Information on LV dyssynchrony can also be provided by gated myocardial perfusion SPECT (GMPS) with phase analysis of regional LV maximal count changes throughout the cardiac cycle which tracks the onset of LV thickening. Purpose of this study was to compare LV dyssynchrony assessment by GMPS and TDI. Methods: In 75 patients with heart failure, depressed LV function and wide QRS complex, GMPS and 2D echocardiography, including TDI, were performed as part of clinical screening for eligibility for CRT. Different parameters (histogram bandwidth, phase standard deviation (SD), histogram skewness and histogram kurtosis) of LV dyssynchrony were assessed from GMPS and compared with LV dyssynchrony on TDI using Pearson's correlation analyses.
Results: Histogram bandwidth and phase SD correlated well with LV dyssynchrony assessed with TDI (r=0.89, P23) R eQ Irv(n-6A7)
10% Good
cerebral function
Moderate
Severe
Vegetative
disability
disabibty
state
Brain death
Electrophysiology Voorzitters Mw. I.C. van Gelder en L.V.A. Boersma
10.15 - 10.30 uur
ATRIAL PACING TO PREVENT PAROXYSMAL ATRIAL FIBRILLATION IN PATIENTS WITHOUT BRADYCARDIA - A RANDOMIZED TRIAL M.E.W. Hemels, J.H. Ruiter2, G.P. Molhoek3, N.J.G.M. Veegerl, D.E.P. De Waard4, R. Van Mechelens, L.H. Savalle6, A.C.P. Wiesfeld', C.J.H.J. Kirchhof7, R. Kessels8, H. Robbe8, I.C. Van Gelderl. 'University Medical Center Groningen, Groningen, 2Medical Center Alkmaar, Alkmaar, 3Medisch Spectrum Twente, Enschede, 4Antonius Hospital, Sneek, 5Sint Fransiscus Gasthuis, Rotterdam, 6Medical Center Haaglanden, Den Haag, 7Rijnlaand Hospital, Leiderdorp, 8Medtronic Bakken Research Center,
Maastricht. Purpose: The Features in AT500rm study; Chances for patients with Episodes of atnal Tachyarrhythmia without bradycardia indication for pacing (FACET), was a prospective, randomized, multicenter, cross-over pilot study to evaluate the efficacy of preventive pacing and antitachycardia pacing (ATP) in patients with symptomatic paroxysmal atrial fibrillation (AF).
Methods: A total of 52 patients with symptomatic paroxysmal AF who failed on at least two different anti-arrhythmic drugs and without bradyarrhythmias were induded. Thirty-eight patients were randomized after a 4 weeks monitor phase post-implant of a DDDRP pacemaker (ATS00, Medtronic Inc., Minneapolis) to prevention and ATP therapies ON or OFF during 12 weeks in each treatment phase with a 4 weeks wash-out phase in between. In the ON phase the lower rate was set on AAI 70 ppm versus MI 34 ppm backup pacing in the monitor, wash out, and OFF phase. The atrial lead was preferably placed in the interatrial septum. Primary endpoint was AF burden.
Results: Mean age of the thirty-eight randomized patients was 6219 years, 53% male, history of mild hypertension 26%, 71% lone AF. Median number of AF episodes during the last 3 months before inclusion was 24 (3-270), median duration was 2.5 hours (0.2-24.0). Septal lead placement was achieved in 68% of patients and in 79% of patients additional class I or III antiarrhythmic drugs were used (stable regime). During treatment there was a trend for AF burden reduction compared to the OFF phase, median AF burden (interquartile range) 2.4% (0.2-12.2) versus 3.3% (1.0-15.2), respectively, p=0.06. In the subgroup of 26 patients with septal lead placement, the reduction of AF burden was significant, median AF burden (interquartile range) 1.4% (0.2-8.4) versus 2.5% (1.0-8.0), respectively, p=0.03. Median efficacy of ATP during active treatment phase was 57±30%. Conclusions: In patients with AF without bradycardia, a hybrid therapy of atrial pacing with atrial prevention and ATP features and antiarrhythmic drugs reduced but not abolished AF, especially if atrial septal pacing could be accomplished.
Abstracts
Sessions Session III, Saturday 28 October 2006 Session IV, Saturday 28 October 2006 Electrophysiology
10.30 - 10.45 uur
Voorzitters Mw. I.C. van Gelder en L.V.A. Boersma
Electrophysiology Voorzitters Mw. I.C. van Gelder en L.V.A. Boersma
10.45 - 11.00 uur
INTENSIVE CHOLESTEROL LOWERING IN COUMARIN-TREATED ELDERLY PATIENTS WITH ATRIAL FIBRILLATION SHIFTS THE A ANTI BALANCE TO MORE THRONBOTICSTATE lanet T van Kuilenburg; Waander van Heerde2; Izabela Plesiewiczl; Paul Lap2; Gheorghe A Pop', Freek W Verheugt1, 'Heart Center Radboud UMCN, Nijmegen, The Netherlands 2Central Laboratory of Haematology Radboud UMCN Nijmegen, the Netherlands.
ATRIAL FIBRILLATION RECURRENCE AFTER CLASSIC MAZE III SURGERY IS RELATED TO INCOMPLETE PULMONARY VEIN TO ABLATION TREATMENT ISOLATION AMENABLE Muchtiar Khan*.MD; Fred H.M. WittkampfA, PhD; Eric F.D. Wever*,MD,PhD; Lucas V.A. Boersman,MD,PhD. *St. Antonius 3435 CM, AAZU, Hospital, Koekoekslaanl, Nieuwegein; Heidelberglaan 100, 3584 CX, Utrecht.
Purpose: In elderly patients with atrial fibrillation (AF) (silent) Ischemic brain infarcts occur despite adequate oral anticoagulation (OAC) therapy. Inflammation and thrombosis are closely related and anti-inflammatory therapy with statins and ezetemibe reduce atherothrombotic events. Our purpose is to examine if this antiinflammatory therapy has an additional effects on the thrombotic proces in patients with. AF with adequate OAC.
Purpose: Maze III surgery for lone paroxysmal atrial fibrillation (AF) shows freedom of arrhythmias In over 80% of patlents. The mechanisms of late recurrences of AF are unclear.
Methods: In 33 elderly AF patients (69-81 years old) without manifest coronary disease or diabetes and with total cholesterol between 4,5 and 7 mmol/l, placebo or atorvastatin 40 mg and ezetemibe 10 mg were given beside OAC therapy (INR 2-3) during 9 months in a randomized double-blind fashion. Cholesterol profile and hsCRP in blood were closely monitored. To investigate coagulation and fibrinolytic activity the Nijmegen Hemostasis assay was used. Prothrombin Activation Fragment (Enzygnost F1+2) analysis was performed to determine in-vivo clotting activity.
Results: F1+2 levels were not significantly different in both groups. However, in the treatment group (n=13) Endogenous Thrombin Potential (ETP) decreased significantly (p=0.002) and Plasmin Peak Height (PPH) showed higher levels (p=0.001); in the placebo group (n=17) no significant changes occurred during follow-up. Whereas mean total cholesterol and hsCRP levels reached a plateau after 3 months, coagulation markers continued to decrease significantly up to 9 months (p
