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Coronary Artery Disease: HELP
Articles by Morten Bøttcher
Based on 21 articles published since 2010
(Why 21 articles?)
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Between 2010 and 2020, M. Bøttcher wrote the following 21 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review A novel approach to diagnosing coronary artery disease: acoustic detection of coronary turbulence. 2017

Thomas, Joseph L / Winther, Simon / Wilson, Robert F / Bøttcher, Morten. ·Division of Cardiology, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 405, Torrance, CA, 90509, USA. jthomas@labiomed.org. · Department of Cardiology B, Aarhus University Hospital, Aarhus N, Denmark. · Division of Cardiology, University of Minnesota School of Medicine, Minneapolis, MN, USA. · Cardiac Imaging Center, Hospital Unit West, Herning, Denmark. ·Int J Cardiovasc Imaging · Pubmed #27581390.

ABSTRACT: Atherosclerotic disease within coronary arteries causes disruption of normal, laminar flow and generates flow turbulence. The characteristic acoustic waves generated by coronary turbulence serve as a novel diagnostic target. The frequency range and timing of microbruits associated with obstructive coronary artery disease (CAD) have been characterized. Technological advancements in sensor, data filtering and analytic capabilities may allow use of intracoronary turbulence for diagnostic and risk stratification purposes. Acoustic detection (AD) systems are based on the premise that the faint auditory signature of obstructive CAD can be isolated and analyzed to provide a new approach to noninvasive testing. The cardiac sonospectrographic analyzer, CADence, and CADScore systems are early-stage, investigational and commercialized examples of AD systems, with the latter two currently undergoing clinical testing with validation of accuracy using computed tomography and invasive angiography. Noninvasive imaging accounts for a large percentage of healthcare expenditures for cardiovascular disease in the developed world, and the growing burden of CAD will disproportionately affect areas in the developing world. AD is a portable, radiation-free, cost-effective method with the potential to provide accurate diagnosis or exclusion of significant CAD. AD represents a model for digital, miniaturized, and internet-connected diagnostic technologies.

2 Article Genetic Risk of Coronary Artery Disease, Features of Atherosclerosis, and Coronary Plaque Burden. 2020

Christiansen, Morten Krogh / Nissen, Louise / Winther, Simon / Møller, Peter Loof / Frost, Lars / Johansen, Jane Kirk / Jensen, Henrik Kjærulf / Guðbjartsson, Daníel / Holm, Hilma / Stefánsson, Kári / Bøtker, Hans Erik / Bøttcher, Morten / Nyegaard, Mette. ·Department of Cardiology Aarhus University Hospital Aarhus Denmark. · Department of Internal Medicine Horsens Regional Hospital Horsens Denmark. · Department of Cardiology Hospital Unit West Herning Denmark. · Department of Biomedicine Aarhus University Aarhus Denmark. · Department of Cardiology Silkeborg Regional Hospital Silkeborg Denmark. · deCODE Genetics/Amgen, Inc. Reykjavik Iceland. ·J Am Heart Assoc · Pubmed #31983321.

ABSTRACT: Background Polygenic risk scores (PRSs) based on risk variants from genome-wide association studies predict coronary artery disease (CAD) risk. However, it is unknown whether the PRS is associated with specific CAD characteristics. Methods and Results We consecutively included 1645 patients with suspected stable CAD undergoing coronary computed tomography angiography. A multilocus PRS was calculated as the weighted sum of CAD risk variants. Plaques were evaluated using an 18-segment model and characterized by stenosis severity and composition (soft [0%-19% calcified], mixed-soft [20%-49% calcified], mixed-calcified [50%-79% calcified], or calcified [≥80% calcified]). Coronary artery calcium score and segment stenosis score were used to characterize plaque burden. For each standard deviation increase in the PRS, coronary artery calcium score increased by 78% (

3 Article Association between circulating proprotein convertase subtilisin/kexin type 9 levels and prognosis in patients with severe chronic kidney disease. 2020

Rasmussen, Laust Dupont / Bøttcher, Morten / Ivarsen, Per / Jørgensen, Hanne Skou / Nyegaard, Mette / Buttenschøn, Henriette / Gustafsen, Camilla / Glerup, Simon / Bøtker, Hans Erik / Svensson, My / Winther, Simon. ·Department of Cardiology, Regional Hospital Unit West Jutland, Herning, Denmark. · Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark. · Department of Biomedicine, Aarhus University, Aarhus, Denmark. · Department of Clinical Medicine, Aarhus University - Translational Neuropsychiatry Unit, Risskov, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Nephrology, Akershus University Hospital, Lørenskog, Norway. · Institute of Clinical Medicine, University of Oslo, Søsterhjemmet, Oslo, Norway. ·Nephrol Dial Transplant · Pubmed #30137516.

ABSTRACT: BACKGROUND: Chronic kidney disease is a risk factor for premature development of coronary atherosclerosis and mortality. A high level of proprotein convertase subtilisin/kexin type 9 (PCSK9) is a recently recognized cardiovascular risk factor and has become the target of effective inhibitory treatment. In 167 kidney transplantation candidates, we aimed to: (i) compare levels of PCSK9 with those of healthy controls, (ii) examine the association between levels of PCSK9 and low-density lipoprotein cholesterol (LDL-c) and the degree of coronary artery disease (CAD) and (iii) evaluate if levels of PCSK9 predict major adverse cardiac events (MACE) and mortality. METHODS: Kidney transplant candidates (n = 167) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) before transplantation. MACE and mortality data were extracted from the Western Denmark Heart Registry, a review of patient records and patient interviews. A group of 79 healthy subjects were used as controls. RESULTS: Mean PCSK9 levels did not differ between healthy controls and kidney transplant candidates. In patients not receiving lipid-lowering therapy, PCSK9 correlated positively with LDL-c (rho = 0.24, P < 0.05). Mean PCSK9 was similar in patients with and without obstructive CAD at both CCTA and ICA. In a multiple regression analysis, PCSK9 was associated with neither LDL-c (β=-6.45, P = 0.44) nor coronary artery calcium score (β=2.17, P = 0.84). During a follow-up of 3.7 years, PCSK9 levels were not associated with either MACE or mortality. CONCLUSIONS: The ability of PCSK9 levels to predict cardiovascular disease and prognosis does not seem to apply to a cohort of kidney transplant candidates.

4 Article Sex Differences in the Association Between Bone Mineral Density and Coronary Artery Disease in Patients Referred for Cardiac Computed Tomography. 2019

Therkildsen, Josephine / Winther, Simon / Nissen, Louise / Jørgensen, Hanne S / Thygesen, Jesper / Ivarsen, Per / Frost, Lars / Isaksen, Christin / Langdahl, Bente L / Hauge, Ellen-Margrethe / Böttcher, Morten. ·Department of Cardiology, Hospital Unit West, Herning, Denmark. Electronic address: josthe@rm.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Hospital Unit West, Herning, Denmark. · Department of Nephrology, Oslo University Hospital, Ullevål, Norway. · Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark. · Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. · Departments of Rheumatology, Aarhus University Hospital, and Clinical Medicine, Aarhus University, Aarhus, Denmark. ·J Clin Densitom · Pubmed #31668962.

ABSTRACT: Atherosclerosis and osteoporosis are both common and preventable diseases. Evidence supports a link between coronary artery disease (CAD) and low bone mineral density (BMD). This study aimed to assess the association between thoracic spine BMD and CAD in men and women with symptoms suggestive of CAD. This cross-sectional study included 1487 (mean age 57 years (range 40-80), 47% men) patients referred for cardiac computed tomography (CT). Agatston coronary artery calcium score (CACS), CAD severity (no, mild, moderate, and severe), vessel involvement (no, 1-, 2-, and 3/left main disease), and invasive measurements were evaluated. BMD of three thoracic vertebrae was measured using quantitative CT. We used the American college of radiology cut-off values for lumbar spine BMD to categorize patients into very low (<80 mg/cm

5 Article Danish study of Non-Invasive testing in Coronary Artery Disease 2 (Dan-NICAD 2): Study design for a controlled study of diagnostic accuracy. 2019

Rasmussen, Laust Dupont / Winther, Simon / Westra, Jelmer / Isaksen, Christin / Ejlersen, June Anita / Brix, Lau / Kirk, Jane / Urbonaviciene, Grazina / Søndergaard, Hanne Maare / Hammid, Osama / Schmidt, Samuel Emil / Knudsen, Lars Lyhne / Madsen, Lene Helleskov / Frost, Lars / Petersen, Steffen E / Gormsen, Lars Christian / Christiansen, Evald Høj / Eftekhari, Ashkan / Holm, Niels Ramsing / Nyegaard, Mette / Chiribiri, Amedeo / Bøtker, Hans Erik / Böttcher, Morten. ·Department of Cardiology, Hospital Unit West, Gl. Landevej 61, Herning, Denmark. Electronic address: lausra@rm.dk. · Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark. · Department of Radiology, Regional Hospital Central Jutland, Falkevej 1A, Silkeborg, Denmark. · Department of Nuclear Medicine, Hospital Unit West, Gl. Landevej 61, Herning, Denmark. · Department of Cardiology, Regional Hospital Central Jutland, Falkevej 1A, Silkeborg, Denmark. · Department of Cardiology, Regional Hospital Central Jutland, Heibergs Allé 4, Viborg, Denmark. · Department of Cardiology, Regional Hospital East Jutland, Skovlyvej 15, Randers, Denmark. · Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. · Department of Cardiology, Hospital Unit West, Gl. Landevej 61, Herning, Denmark. · Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom. · Department of Nuclear Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark. · Department of Biomedicine, Aarhus University, Aarhus, Denmark. · Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom. · Department of Cardiology, Hospital Unit West, Gl. Landevej 61, Herning, Denmark. Electronic address: morboett@rm.dk. ·Am Heart J · Pubmed #31323454.

ABSTRACT: BACKGROUND: Coronary computed tomography angiography (CTA) is the preferred primary diagnostic modality when examining patients with low to intermediate pre-test probability of coronary artery disease (CAD). Only 20-30% of these have potentially obstructive CAD. Because of the relatively poor positive predictive value of coronary CTA, unnecessary invasive coronary angiographies (ICAs) are conducted with the costs and risks associated with the procedure. Hence, an optimized diagnostic CAD algorithm may reduce the numbers of ICAs not followed by revascularization. The Dan-NICAD 2 study has 3 equivalent main aims: (1) To examine the diagnostic precision of a sound-based diagnostic algorithm, The CADScor®System (Acarix A/S, Denmark), in patients with a low to intermediate pre-test risk of CAD referred to a primary examination by coronary CTA. We hypothesize that the CADScor®System provides better stratification prior to coronary CTA than clinical risk stratification scores alone. (2) To compare the diagnostic accuracy of 3T cardiac magnetic resonance imaging (3T CMRI), METHODS: Dan-NICAD 2 is a prospective, multicenter, cross-sectional study including approximately 2,000 patients with low to intermediate pre-test probability of CAD and without previous history of CAD. Patients are referred to coronary CTA because of symptoms suggestive of CAD, as evaluated by a cardiologist. Patient interviews, sound recordings, and blood samples are obtained in connection with the coronary CTA. If coronary CTA does not rule out obstructive CAD, patients will be examined by 3T CMRI DISCUSSION: The results of the Dan-NICAD 2 study are expected to contribute to the improvement of diagnostic strategies for patients suspected of CAD in 3 different steps: risk stratification prior to coronary CTA, diagnostic strategy after coronary CTA, and invasive wireless QFR analysis as an alternative to ICA-FFR.

6 Article Influence of Cardiac CT based disease severity and clinical symptoms on the diagnostic performance of myocardial perfusion. 2019

Nissen, L / Winther, S / Westra, J / Ejlersen, J A / Isaksen, C / Rossi, A / Holm, N R / Urbonaviciene, G / Gormsen, L C / Madsen, L H / Christiansen, E H / Maeng, M / Knudsen, L L / Frost, L / Brix, L / Bøtker, H E / Petersen, S E / Bøttcher, M. ·Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark. lounisse@rm.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Nuclear Medicine, Hospital Unit West Jutland, Herning, Denmark. · Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Biomedical Sciences, Humanitas University, Milan, Italy. · Department of Diagnostic Imaging, Humanitas Research Hospital, Milan, Italy. · Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark. · William Harvey Research Institute, Queen Mary University of London, London, UK. · St. Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK. ·Int J Cardiovasc Imaging · Pubmed #31016502.

ABSTRACT: We aimed to identify factors influencing the sensitivity of perfusion imaging after an initial positive coronary computed tomography angiography (CCTA) using invasive coronary angiography (ICA) with conditional fractional flow reserve (FFR) as reference. Secondly we aimed to identify factors associated with revascularisation and to evaluate treatment outcome after ICA. We analysed 292 consecutive patients with suspected significant coronary artery disease (CAD) at CCTA, who underwent perfusion imaging with either cardiac magnetic resonance (CMR) or myocardial perfusion scintigraphy (MPS) followed by ICA with conditional FFR. Stratified analysis and uni- and multiple logistic regression analyses were performed to identify predictors of diagnostic agreement between perfusion scans and ICA and predictors of revascularisation. Myocardial ischemia evaluated with perfusion scans was present in 65/292 (22%) while 117/292 (40%) had obstructive CAD evaluated by ICA. Revascularisation rate was 90/292 (31%). The overall sensitivity for perfusion scans was 39% (30-48), specificity 89% (83-93), PPV 69% (57-80) and NPV 68% (62-74). Stratified analysis showed higher sensitivities in patients with multi-vessel disease at CCTA 49% (37-60) and typical chest pain 50% (37-60). Predictors of revascularisation were multi-vessel disease by CCTA (OR 3.51 [1.91-6.48]) and a positive perfusion scan (OR 4.69 [2.49-8.83]). The sensitivity for perfusion scans after CCTA was highest in patients with typical angina and multiple lesions at CCTA and predicted diagnostic agreement between perfusion scans and ICA. Abnormal perfusion and multi vessel disease at CCTA predicted revascularisation.

7 Article Sclerostin is not associated with cardiovascular event or fracture in kidney transplantation candidates
. 2018

Jørgensen, Hanne Skou / Winther, Simon / Dupont, Laust / Bøttcher, Morten / Rejnmark, Lars / Hauge, Ellen-Margrethe / Svensson, My / Ivarsen, Per. · ·Clin Nephrol · Pubmed #29701175.

ABSTRACT: BACKGROUND: Sclerostin, a bone-derived protein, has been linked to cardiovascular calcifications in chronic kidney disease (CKD). The aim of this study was to investigate the associations between sclerostin and mineral and bone disorder in CKD, specifically whether sclerostin levels could predict cardiovascular event, fracture, or all-cause mortality. MATERIALS AND METHODS: Kidney transplantation candidates (n = 157) underwent computed tomography scans of the chest, abdomen, and pelvis. Calcification scores were calculated for coronary arteries, thoracic aorta, and the aortic and mitral valves. Volumetric bone mineral density (BMD) was measured at the spine and hip. Sclerostin and markers of bone turnover were determined from fasting blood samples. RESULTS: Compared to patients with a calcification score of 0, sclerostin levels were higher in patients with calcifications at the coronary arteries (+23%, p < 0.001) and the thoracic aorta (+27%, p = 0.001), but not in patients with calcifications at the aortic (+1%, p = 0.85) or mitral (+8%, p = 0.20) valves. During a median follow-up of 3.7 years, 28 patients had a major cardiovascular event, 19 patients sustained a fragility fracture, and 32 patients died. Sclerostin levels above the median did not predict major cardiovascular event (p = 0.15), fracture (p = 0.58), or mortality (p = 0.65). CONCLUSION: Sclerostin was positively associated with the presence of vascular calcifications, but was not predictive of events associated with mineral and bone disorder in a cohort of kidney transplantation candidates.
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8 Article Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography: The WIFI II Study (Wire-Free Functional Imaging II). 2018

Westra, Jelmer / Tu, Shengxian / Winther, Simon / Nissen, Louise / Vestergaard, Mai-Britt / Andersen, Birgitte Krogsgaard / Holck, Emil Nielsen / Fox Maule, Camilla / Johansen, Jane Kirk / Andreasen, Lene Nyhus / Simonsen, Jo Krogsgaard / Zhang, Yimin / Kristensen, Steen Dalby / Maeng, Michael / Kaltoft, Anne / Terkelsen, Christian Juhl / Krusell, Lars Romer / Jakobsen, Lars / Reiber, Johan H C / Lassen, Jens Flensted / Bøttcher, Morten / Bøtker, Hans Erik / Christiansen, Evald Høj / Holm, Niels Ramsing. ·From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.) · Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.) · Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.) · Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.) · and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.). ·Circ Cardiovasc Imaging · Pubmed #29555835.

ABSTRACT: BACKGROUND: Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire-Free Functional Imaging II) was to evaluate the feasibility and diagnostic performance of QFR in unselected consecutive patients. METHODS AND RESULTS: WIFI II was a predefined substudy to the Dan-NICAD study (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease), referring 362 consecutive patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50±12%. Mean difference between FFR and QFR was 0.01±0.08. QFR correctly classified 83% of the lesions using FFR with cutoff at 0.80 as reference standard. The area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.81-0.91) with a sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 86%, 75%, and 87%, respectively. A QFR-FFR hybrid approach based on the present results enables wire-free and adenosine-free procedures in 68% of cases. CONCLUSIONS: Functional lesion evaluation by QFR assessment showed good agreement and diagnostic accuracy compared with FFR. Studies comparing clinical outcome after QFR- and FFR-based diagnostic strategies are required. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02264717.

9 Article Diagnosing coronary artery disease after a positive coronary computed tomography angiography: the Dan-NICAD open label, parallel, head to head, randomized controlled diagnostic accuracy trial of cardiovascular magnetic resonance and myocardial perfusion scintigraphy. 2018

Nissen, L / Winther, S / Westra, J / Ejlersen, J A / Isaksen, C / Rossi, A / Holm, N R / Urbonaviciene, G / Gormsen, L C / Madsen, L H / Christiansen, E H / Maeng, M / Knudsen, L L / Frost, L / Brix, L / Bøtker, H E / Petersen, S E / Bøttcher, M. ·Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark. · Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. · Department of Nuclear Medicine, Regional Hospital West Jutland, Gl.landevej 61, 7400 Herning, Denmark. · Department of Radiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark. · William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK. · Department of Cardiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark. · Department of Nuclear Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. ·Eur Heart J Cardiovasc Imaging · Pubmed #29447342.

ABSTRACT: Aims: Perfusion scans after coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD) may reduce unnecessary invasive coronary angiographies (ICAs). However, the diagnostic accuracy of perfusion scans after primary CCTA is unknown. The aim of this study was to determine the diagnostic accuracy of cardiac magnetic resonance (CMR) and myocardial perfusion scintigraphy (MPS) against ICA with fractional flow reserve (FFR) in patients suspected of CAD by CCTA. Methods and results: Included were consecutive patients (1675) referred to CCTA with symptoms of CAD and low/intermediate risk profile. Patients with suspected CAD based on CCTA were randomized 1:1 to CMR or MPS followed by ICA with FFR. Obstructive CAD was defined as FFR ≤ 0.80 or > 90% diameter stenosis by visual assessment. After initial CCTA, 392 patients (23%) were randomized; 197 to CMR and 195 to MPS. Perfusion scans and ICA were completed in 292 patients (CMR 148, MPS 144). Based on the ICA, 117/292 (40%) patients were classified with CAD. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for CMR were 41%, 95% CI [28-54], 84% [75-91], 62% [45-78], and 68% [58-76], respectively. For the MPS group 36% [24-50], 94% [87-98], 81% [61-93], and 68% [59-76], respectively. Conclusion: Patients with low/intermediate CAD risk and a positive CCTA scan represent a challenge to perfusion techniques indicated by the low sensitivity of both CMR and MPS with FFR as a reference. The mechanisms underlying this discrepancy need further investigation.

10 Article Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification. 2018

Winther, Simon / Nissen, Louise / Schmidt, Samuel Emil / Westra, Jelmer Sybren / Rasmussen, Laust Dupont / Knudsen, Lars Lyhne / Madsen, Lene Helleskov / Kirk Johansen, Jane / Larsen, Bjarke Skogstad / Struijk, Johannes Jan / Frost, Lars / Holm, Niels Ramsing / Christiansen, Evald Høj / Botker, Hans Erik / Bøttcher, Morten. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Hospital Unit West, Herning, Denmark. · Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. · Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. ·Heart · Pubmed #29122932.

ABSTRACT: OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography. If significant obstruction was suspected in any coronary segment, patients were referred to invasive angiography and fractional flow reserve (FFR) assessment. Heart sound analysis was performed in all patients. A predefined acoustic CAD-score algorithm was evaluated; subsequently, we developed and validated an updated CAD-score algorithm that included both acoustic features and clinical risk factors. Low risk is indicated by a CAD-score value ≤20. RESULTS: Haemodynamically significant CAD assessed from FFR was present in 145 (10.0%) patients. In the entire cohort, the predefined CAD-score had a sensitivity of 63% and a specificity of 44%. In total, 50% had an updated CAD-score value ≤20. At this cut-off, sensitivity was 81% (95% CI 73% to 87%), specificity 53% (95% CI 50% to 56%), positive predictive value 16% (95% CI 13% to 18%) and negative predictive value 96% (95% CI 95% to 98%) for diagnosing haemodynamically significant CAD. CONCLUSION: Sound-based detection of CAD enables risk stratification superior to clinical risk scores. With a negative predictive value of 96%, this new acoustic rule-out system could potentially supplement clinical assessment to guide decisions on the need for further diagnostic investigation. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier NCT02264717; Results.

11 Article Prognostic Value of Risk Factors, Calcium Score, Coronary CTA, Myocardial Perfusion Imaging, and Invasive Coronary Angiography in Kidney Transplantation Candidates. 2018

Winther, Simon / Svensson, My / Jørgensen, Hanne Skou / Rasmussen, Laust Dupont / Holm, Niels Ramsing / Gormsen, Lars Christian / Bouchelouche, Kirsten / Bøtker, Hans Erik / Ivarsen, Per / Bøttcher, Morten. ·Department of Cardiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Hospital Unit West, Herning, Denmark. Electronic address: sw@dadlnet.dk. · Department of Nephrology, Division of Medicine, Akershus University Hospital, Oslo, Norway. · Department of Nephrology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. · Department of Cardiology, Hospital Unit West, Herning, Denmark. · Department of Cardiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. · Department of Nuclear Medicine and PET-Center, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. ·JACC Cardiovasc Imaging · Pubmed #28917674.

ABSTRACT: OBJECTIVES: This study sought to perform a prospective head-to-head comparison of the predictive value of clinical risk factors and a variety of cardiac imaging modalities including coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography (ICA) on major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates. BACKGROUND: Current guidelines recommend screening for coronary artery disease in kidney transplantation candidates. Furthermore, noninvasive stress imaging is recommended in current guidelines, despite its low diagnostic accuracy and uncertain prognostic value. METHODS: The study prospectively evaluated 154 patients referred for kidney transplantation. All patients underwent CACS, coronary CTA, SPECT, and ICA testing. The clinical endpoints were extracted from patients' interviews, patients' records, and registries. RESULTS: The mean follow-up time was 3.7 years. In total, 27 (17.5%) patients experienced MACE, and 31 (20.1%) patients died during follow-up. In a time-to-event analysis, both risk factors and CACS significantly predicted death, but only CACS predicted MACE. Combining risk factors with CACS identified a very-low-risk cohort with a MACE event rate of 2.1%, and a 1.0% mortality rate per year. Of the diagnostic modalities, coronary CTA and ICA significantly predicted MACE, but only coronary CTA predicted death. In contrast, SPECT predicted neither MACE nor death. CONCLUSIONS: Compared with traditional risk factors and other cardiac imaging modalities, CACS and coronary CTA seem superior for risk stratification in kidney transplant candidates. Applying a combination of risk factors and CACS and subsequently coronary CTA seems to be the most appropriate strategy. (Angiographic CT of Renal Transplantation Candidate Study [ACToR]; NCT01344434).

12 Article Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study. 2017

Nielsen, Lene H / Bøtker, Hans Erik / Sørensen, Henrik T / Schmidt, Morten / Pedersen, Lars / Sand, Niels Peter / Jensen, Jesper M / Steffensen, Flemming H / Tilsted, Hans Henrik / Bøttcher, Morten / Diederichsen, Axel / Lambrechtsen, Jess / Kristensen, Lone D / Øvrehus, Kristian A / Mickley, Hans / Munkholm, Henrik / Gøtzsche, Ole / Husain, Majed / Knudsen, Lars L / Nørgaard, Bjarne L. ·Department of Cardiology, Lillebaelt Hospital-Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Hospital of South West Jutland, Esbjerg, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Regional Hospital Herning, Herning, Denmark. · Department of Cardiology, Odense University Hospital, Denmark. · Department of Cardiology, Svendborg Hospital, Denmark. · Department of Cardiology, Regional Hospital Silkeborg, Silkeborg, Denmark. ·Eur Heart J · Pubmed #27941018.

ABSTRACT: Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity. Methods and results: This cohort study included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death. The Kaplan-Meier estimator was used to compute 91 day to 3.5 year risk according to the CAD severity. Comparisons between patients with and without CAD were based on Cox-regression adjusted for age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac medications, and post-CCTA treatment within 90 days. The composite endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5% for patients without CAD, 6.8% for obstructive CAD, and 15% for three-vessel/left main disease. Compared with patients without CAD, higher relative risk of the composite endpoint was observed for non-obstructive CAD [hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.01-1.63], obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95% CI :2.90-6.69). The results were consistent in strata of age, sex, and comorbidity. Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.

13 Article Association Between Changes in Coronary Artery Disease Progression and Treatment With Biologic Agents for Severe Psoriasis. 2016

Hjuler, Kasper Fjellhaugen / Bøttcher, Morten / Vestergaard, Christian / Bøtker, Hans Erik / Iversen, Lars / Kragballe, Knud. ·Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark. · Department of Internal Medicine, Cardiac Imaging Center, Hospital Unit West, Herning, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. ·JAMA Dermatol · Pubmed #27385305.

ABSTRACT: Importance: Inflammatory pathways of psoriasis share similarities with the mechanisms identified in atherosclerosis, and the association between psoriasis and cardiovascular disease due to accelerated coronary artery disease is well established. The effect of anti-inflammatory drugs on the development of coronary atherosclerosis remains essentially unknown. Objective: To investigate the association of biological therapy with changes in coronary artery disease progression, measured by repeated coronary computed tomography (CT). Design, Setting, and Participants: This single-center prospective, controlled, observer-blinded clinical study at a tertiary dermatology university hospital clinic enrolled patients with severe psoriasis initiating biological therapy and matched controls not receiving systemic therapy from April 11, 2011, through June 30, 2014. Interventions: Biological therapy approved for psoriasis (adalimumab, etanercept, infliximab, ustekinumab) with the possibility to switch between treatments to ensure tight control of inflammation. Main Outcomes and Measures: Patients underwent noncontrast coronary artery calcium (CAC) CT and contrast-enhanced coronary CT angiography at baseline and after 13 months of follow-up. Changes in CAC score, number of coronary plaques, severity of narrowing, composition, and vessel wall volume were measured. Results: There were 28 treated patients (mean [SD] age, 49.2 [10.2] years; 71% men; mean [SD] Psoriasis Area Severity Index [PASI], 15.4 [4.3]) and 28 controls (mean [SD] age, 52.8 [10.6] years; 71% men; mean [SD] PASI, 12.4 [3.9]). The CAC scores remained stable in the intervention group (mean [SD] yearly CAC change, -16 [56]; P = .15) and progressed in the control group (14 [29]; P = .02) (intervention vs controls: P = .02). The number of segments with luminal abnormalities remained unchanged in both groups. The severity of luminal narrowing in the diseased segments was unchanged in the intervention group (Wilcoxon W = 76, n = 483, P = .39) but increased at follow-up in the control group (Wilcoxon W = 281, n = 414, P = .02). Automated vessel wall volume index remained unchanged from baseline to follow-up in the intervention group (mean [SD] baseline, 7.1 [1.5], follow-up, 7.1 [1.7]; P = .91), while controls demonstrated statistically nonsignificant progression (baseline, 8.3 [1.6], follow-up, 8.9 [2.2]; P = .06). Conclusions and Relevance: Clinically effective treatment with biologic agents was associated with reduced coronary artery disease progression in patients with severe psoriasis. These findings support a beneficial effect of biologic anti-inflammatory agents in preventing cardiovascular disease progression in addition to disease control in inflammatory diseases.

14 Article Danish study of Non-Invasive testing in Coronary Artery Disease (Dan-NICAD): study protocol for a randomised controlled trial. 2016

Nissen, Louise / Winther, Simon / Isaksen, Christin / Ejlersen, June Anita / Brix, Lau / Urbonaviciene, Grazina / Frost, Lars / Madsen, Lene Helleskov / Knudsen, Lars Lyhne / Schmidt, Samuel Emil / Holm, Niels Ramsing / Maeng, Michael / Nyegaard, Mette / Bøtker, Hans Erik / Bøttcher, Morten. ·Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark. lounisse@rm.dk. · Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Nuclear Medicine, Hospital Unit West, Herning, Denmark. · Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark. · Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. · Department of Biomedicine, Aarhus University, Aarhus, Denmark. ·Trials · Pubmed #27225018.

ABSTRACT: BACKGROUND: Coronary computed tomography angiography (CCTA) is an established method for ruling out coronary artery disease (CAD). Most patients referred for CCTA do not have CAD and only approximately 20-30 % of patients are subsequently referred to further testing by invasive coronary angiography (ICA) or non-invasive perfusion evaluation due to suspected obstructive CAD. In cases with severe calcifications, a discrepancy between CCTA and ICA often occurs, leading to the well-described, low-diagnostic specificity of CCTA. As ICA is cost consuming and involves a risk of complications, an optimized algorithm would be valuable and could decrease the number of ICAs that do not lead to revascularization. The primary objective of the Dan-NICAD study is to determine the diagnostic accuracy of cardiac magnetic resonance imaging (CMRI) and myocardial perfusion scintigraphy (MPS) as secondary tests after a primary CCTA where CAD could not be ruled out. The secondary objective includes an evaluation of the diagnostic precision of an acoustic technology that analyses the sound of coronary blood flow. It may potentially provide better stratification prior to CCTA than clinical risk stratification scores alone. METHODS/DESIGN: Dan-NICAD is a multi-centre, randomised, cross-sectional trial, which will include approximately 2,000 patients without known CAD, who were referred to CCTA due to a history of symptoms suggestive of CAD and a low-risk to intermediate-risk profile, as evaluated by a cardiologist. Patient interview, sound recordings, and blood samples are obtained in connection with the CCTA. All patients with suspected obstructive CAD by CCTA are randomised to either stress CMRI or stress MPS, followed by ICA with fractional flow reserve (FFR) measurements. Obstructive CAD is defined as an FFR below 0.80 or as high-grade stenosis (>90 % diameter stenosis) by visual assessment. Diagnostic performance is evaluated as sensitivity, specificity, predictive values, likelihood ratios, and C statistics. Enrolment commenced in September 2014 and is expected to be complete in May 2016. DISCUSSION: Dan-NICAD is designed to assess whether a secondary perfusion examination after CCTA could safely reduce the number of ICAs where revascularization is not required. The results are expected to add knowledge about the optimal algorithm for diagnosing CAD. TRIAL REGISTRATION: Clinicaltrials.gov identifier, NCT02264717 . Registered on 26 September 2014.

15 Article Coronary Calcium Score May Replace Cardiovascular Risk Factors as Primary Risk Stratification Tool Before Kidney Transplantation. 2016

Winther, Simon / Bøttcher, Morten / Jørgensen, Hanne S / Bouchelouche, Kirsten / Gormsen, Lars C / Oczachowska-Kulik, Anna E / Holm, Niels R / Bøtker, Hans Erik / Ivarsen, Per R / Svensson, My. ·1 Department of Cardiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus, Denmark. 2 Department of Internal Medicine, Hospital Unit West, Herning, Denmark. 3 Department of Nephrology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus, Denmark. 4 Department of Nuclear Medicine and PET-Center, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus, Denmark. 5 University Clinic in Nephrology and Hypertension, Department of Medical Research and University of Aarhus, Holstebro Hospital, Holstebro, Denmark. 6 Department of Nephrology, Akershus University Hospital, University of Oslo, Oslo, Norway. ·Transplantation · Pubmed #26555948.

ABSTRACT: BACKGROUND: Cardiac evaluation before kidney transplantation is recommended, but no unequivocal screening strategy has yet been identified. We investigated if coronary artery calcium score (CACS) can replace cardiovascular risk factor assessment in selection of kidney transplantation candidates for cardiac evaluation and the choice of noninvasive modality for diagnosing obstructive coronary artery disease (CAD). METHODS: We conducted a prospective study of 167 patients referred for pretransplantation cardiac evaluation. Patients underwent risk factor assessment, CACS, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography. In total, 138 patients completed all diagnostic tests. RESULTS: In patients with CAD (22%), the number of risk factors and CACS score were higher than that in patients without CAD. The accuracy evaluated by the receiver-operating characteristic curve was higher for CACS than for risk factors, 0.85 versus 0.71 (P = 0.01). Adding CACS to the risk factor increased correct categorical net reclassification (0.58, P < 0.0001). Combining risk factors (≥3) with SPECT to identify patients with obstructive CAD resulted in less sensitivity (47% vs 80%) and higher specificity (94% vs 74%), compared with CCTA. In patients with low CACS (<400), SPECT had a lower sensitivity than CCTA (60% versus 80%) but the same specificity (80%). In patients with high CACS (≥400), SPECT had lower sensitivity than CCTA (50% vs 100%) and higher specificity (88% vs 8%). CONCLUSIONS: In kidney transplantation candidates, CACS outperformed risk factor assessment for predicting obstructive CAD and is a better tool for selecting patients and guiding the choice of noninvasive diagnostic modality in CAD.

16 Article Diagnosing coronary artery disease by sound analysis from coronary stenosis induced turbulent blood flow: diagnostic performance in patients with stable angina pectoris. 2016

Winther, Simon / Schmidt, Samuel Emil / Holm, Niels Ramsing / Toft, Egon / Struijk, Johannes Jan / Bøtker, Hans Erik / Bøttcher, Morten. ·Department of Cardiology, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark. sw@dadlnet.dk. · Department of Internal Medicine, Hospital Unit West, Herning, Denmark. sw@dadlnet.dk. · Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. · Department of Cardiology, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark. · College of Medicine, Qatar University, Doha, Qatar. · Department of Internal Medicine, Hospital Unit West, Herning, Denmark. ·Int J Cardiovasc Imaging · Pubmed #26335368.

ABSTRACT: Optimizing risk assessment may reduce use of advanced diagnostic testing in patients with symptoms suggestive of stable coronary artery disease (CAD). Detection of diastolic murmurs from post-stenotic coronary turbulence with an acoustic sensor placed on the chest wall can serve as an easy, safe, and low-cost supplement to assist in the diagnosis of CAD. The aim of this study was to evaluate the diagnostic accuracy of an acoustic test (CAD-score) to detect CAD and compare it to clinical risk stratification and coronary artery calcium score (CACS). We prospectively enrolled patients with symptoms of CAD referred to either coronary computed tomography or invasive coronary angiography (ICA). All patients were tested with the CAD-score system. Obstructive CAD was defined as more than 50 % diameter stenosis diagnosed by quantitative analysis of the ICA. In total, 255 patients were included and obstructive CAD was diagnosed in 63 patients (28 %). Diagnostic accuracy evaluated by receiver operating characteristic curves was 72 % for the CAD-score, which was similar to the Diamond-Forrester clinical risk stratification score, 79 % (p = 0.12), but lower than CACS, 86 % (p < 0.01). Combining the CAD-score and Diamond-Forrester score, AUC increased to 82 %, which was significantly higher than the standalone CAD-score (p < 0.01) and Diamond-Forrester score (p < 0.05). Addition of the CAD-score to the Diamond-Forrester score increased correct reclassification, categorical net-reclassification index = 0.31 (p < 0.01). This study demonstrates the potential use of an acoustic system to identify CAD. The combination of clinical risk scores and an acoustic test seems to optimize patient selection for diagnostic investigation.

17 Article Increased Prevalence of Coronary Artery Disease in Severe Psoriasis and Severe Atopic Dermatitis. 2015

Hjuler, Kasper Fjellhaugen / Böttcher, Morten / Vestergaard, Christian / Deleuran, Mette / Raaby, Line / Bøtker, Hans Erik / Iversen, Lars / Kragballe, Knud. ·Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: kasped@rm.dk. · Department of Internal Medicine, Hospital Unit West, Herning, Denmark. · Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. ·Am J Med · Pubmed #26093174.

ABSTRACT: BACKGROUND: Psoriasis and atopic dermatitis (AD) are immuno-inflammatory diseases that can result in lifelong systemic inflammation. Unlike AD, psoriasis has been associated with cardiovascular disease. The aim of this study was to examine the prevalence, severity, and subtype of coronary artery disease (CAD) in psoriasis and AD patients without known cardiovascular disease. METHODS: Consecutively enrolled patients (psoriasis n = 58, AD n = 31) and retrospectively matched controls (n = 33) were examined using cardiac computed tomography angiography (CCTA) and assessed using an 18-segment model of the coronary tree. RESULTS: The prevalence of a coronary artery calcium score >0 was 29.8% in psoriasis and 45.2% in AD, vs 15.2% in controls (P = .09 and P = .01, respectively). More patients with psoriasis had a coronary artery calcium score ≥100 (psoriasis 19.3%, controls 2.9%; P = .02). CCTA showed the presence of plaques in 38.2% of psoriasis patients and 48.1% of AD patients, vs 21.2% of controls (P = .08 and P = .03, respectively). Psoriasis was associated with an increased prevalence of significant coronary stenosis (stenosis >70%) (psoriasis 14.6%, controls 0%; P = .02) and 3-vessel coronary affection or left main artery disease (psoriasis 20%, controls 3%; P = .02), whereas AD was associated with mild (AD 40.7%, controls 9.1%; P = .005) single-vessel affection. CONCLUSIONS: These findings suggest that psoriasis and AD are associated with an increased prevalence of CAD. Patients with psoriasis have an increased prevalence of severe CAD.

18 Article Diagnostic Performance of Coronary CT Angiography and Myocardial Perfusion Imaging in Kidney Transplantation Candidates. 2015

Winther, Simon / Svensson, My / Jørgensen, Hanne Skou / Bouchelouche, Kirsten / Gormsen, Lars Christian / Pedersen, Birgitte Bang / Holm, Niels Ramsing / Bøtker, Hans Erik / Ivarsen, Per / Bøttcher, Morten. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: sw@dadlnet.dk. · Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark. · Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Denmark. · Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Internal Medicine, Hospital Unit West, Herning, Denmark. ·JACC Cardiovasc Imaging · Pubmed #25869350.

ABSTRACT: OBJECTIVES: The goal of this study was to compare the diagnostic accuracy of the coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and a combination of these tools in the diagnosis of obstructive coronary artery disease (CAD) in patients with chronic kidney disease referred for cardiac evaluation before kidney transplantation. BACKGROUND: The optimal method for the detection of obstructive CAD in potential kidney transplant patients has not yet been identified. Previous studies have found that established noninvasive stress tests have low diagnostic accuracy, while the diagnostic performance of coronary CTA remains unknown. METHODS: We prospectively studied 138 patients referred for pre-transplant cardiac evaluation (mean age 54 years; age range 22 to 72 years; 68% male; 43% treated with dialysis). All patients underwent CACS, coronary CTA, SPECT, and invasive coronary angiography. The results of the noninvasive tests were merged into integrated hybrid imaging results: Hybrid (CACS/SPECT) and Hybrid (coronary CTA/SPECT). RESULTS: The overall prevalence of obstructive CAD (≥50% reduction in luminal diameter) according to quantitative invasive coronary angiography was 22%. Two-thirds of the patients with obstructive CAD had a stenosis located in a proximal coronary segment. In a patient-level model, the sensitivity and specificity, respectively, for diagnosing obstructive CAD were as follows: CACS (threshold of 400), 67% and 77%; coronary CTA, 93% and 63%; SPECT, 53% and 82%; Hybrid (CACS/SPECT), 33% and 97%; and Hybrid (coronary CTA/SPECT), 67% and 86%. The sensitivity for diagnosing obstructive CAD in a proximal segment was 70% for CACS (threshold 400), 100% for coronary CTA, 60% for SPECT, 40% for Hybrid (CACS/SPECT), and 75% for Hybrid (coronary CTA/SPECT). CONCLUSIONS: Coronary CTA is a reliable test with high sensitivity and a high negative predictive value for diagnosing obstructive CAD before kidney transplantation. A noninvasive approach with use of either coronary CTA or a combination of coronary CTA and SPECT to rule out obstructive CAD seems recommendable in kidney transplant candidates. (ACToR-Study: Angiographic CT of Renal Transplantation Candidate-Study; NCT01344434).

19 Article Impact of luminal density on plaque classification by CT coronary angiography. 2011

Dalager, Maiken Glud / Bøttcher, Morten / Andersen, Gratien / Thygesen, Jesper / Pedersen, Erik Morre / Dejbjerg, Lone / Gøtzsche, Ole / Bøtker, Hans Erik. ·Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark. maikendalager@gmail.com ·Int J Cardiovasc Imaging · Pubmed #20820922.

ABSTRACT: CONCLUSION: Non-calcified plaques can be identified and classified by CCTA. However, the luminal density affects the absolute HU of both non-calcified and calcified plaques. Characterization and classification of non-calcified plaques by absolute CT values therefore requires standardization of contrast protocols.

20 Article Comparison of usefulness of exercise testing versus coronary computed tomographic angiography for evaluation of patients suspected of having coronary artery disease. 2010

Ovrehus, Kristian A / Jensen, Jesper K / Mickley, Hans F / Munkholm, Henrik / Bøttcher, Morten / Bøtker, Hans E / Nørgaard, Bjarne L. ·Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark. kristianovrehus@hotmail.com ·Am J Cardiol · Pubmed #20211318.

ABSTRACT: In patients suspected of having coronary artery disease (CAD), we compared the diagnostic sensitivity and specificity of exercise testing using ST-segment changes alone and ST-segment changes, angina pectoris, and hemodynamic variables compared to coronary computed tomographic angiography (CTA). Quantitative invasive coronary angiography was the reference method (>50% coronary lumen reduction). A positive exercise test was defined as the development of significant ST-segment changes (> or =1 mV measured 80 ms from the J-point), and the occurrence of one or more of the following criteria: ST-segment changes > or =1 mV measured 80 ms from the J-point, angina pectoris, ventricular arrhythmia (the occurrence of > or =3 premature ventricular beats), and > or =20 mm Hg decrease in systolic blood pressure during the test. Positive results on CTA were defined as a coronary lumen reduction of > or =50%. In 100 patients (61 +/- 9 years old, 50% men, and 29% prevalence of significant CAD), the diagnostic sensitivity and specificity of exercise testing using ST-segment changes was 45% (95% confidence interval 53% to 87%) and 63% (95% confidence interval 61% to 84%), respectively. However, the inclusion of all test variables yielded a sensitivity of 72% (95% confidence interval 53% to 87%) and a specificity of 37% (95% confidence interval 26% to 49%). The diagnostic sensitivity of 97% (95% confidence interval 82% to 100%) and specificity of 80% (95% confidence interval 69% to 89%) for CTA, however, were superior to any of the exercise test analysis strategies. In conclusion, in patients suspected of having CAD, the diagnostic sensitivity of exercise testing significantly improves if all test variables are included compared to using ST-segment changes exclusively. Furthermore, the superior diagnostic performance of CTA for the detection and exclusion of significant CAD might favor CTA as the first-line diagnostic test in patients suspected of having CAD.

21 Minor The Authors Reply. 2016

Winther, Simon / Svensson, My / Jørgensen, Hanne Skou / Bouchelouche, Kirsten / Gormsen, Lars Christian / Pedersen, Birgitte Bang / Holm, Niels Ramsing / Bøtker, Hans Erik / Ivarsen, Per / Bøttcher, Morten. · ·JACC Cardiovasc Imaging · Pubmed #26965737.

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