The interest in rotational atherectomy (RA) has increased over the past decade as a consequence of more complex and calcified coronary stenoses being attempted with percutaneous coronary interventions. Yet adoption of RA is hampered by several factors: amongst others, by the lack of a standardised protocol. This European expert consensus document stems from the awareness of the large heterogeneity in the protocols adopted to perform rotational atherectomy. The objective of the present document is to provide some points of consensus among highly experienced operators on the most controversial steps of RA in an attempt to build the basis of a standardised and universally accepted protocol.

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AimsBone status has not been comprehensively studied in chronic heart failure (CHF). In CHF men, we evaluated bone status, bone loss over time, and their clinical and hormonal determinants. Methods and resultsBone mineral content (BMC) and bone mineral density (BMD) of arms, legs, trunk, and total body were examined using dual-energy X-ray absorptiometry in 187 men with CHF [age: 60+11 years, left ventricular ejection fraction (LVEF): 32+7%, New York Heart Association (NYHA) class (I/II/III/IV): 20/76/76/15] and in 21 age-matched male controls without CHF. Men with CHF had reduced BMD and BMC compared with controls (P , 0.05). Reduced BMD and BMC were independently determined by CHF severity (high NYHA class and impaired LVEF), reduced lean tissue mass, low serum dehydroepiandrosterone sulphate, total testosterone (TT), and estimated free testosterone (eFT) (all P , 0.05). Bone status was reassessed in 60 patients who survived .2 years from the initial evaluation. Significant bone loss over time (a reduction in BMC total 1%/year) occurred in 35% of CHF men. Advanced NYHA class (P , 0.05) and reduced serum TT and eFT (P , 0.0001) at baseline predicted augmented bone loss. ConclusionIn CHF men, reduced BMD and BMC constitute an element of generalized body wasting, determined mainly by advanced heart failure and androgen deficiencies. Significant bone loss over time frequently occurs in CHF men and is related to testosterone depletion and disease severity.--

Recent experimental studies have postulated that the altered metabolism of estrogens and the deranged ex-pression of their receptors may be involved in the pathophysiology of chronic heart failure (HF). [7][8][9][10][11]15 The See also Patient Page.

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