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Coronary Artery Disease: HELP
Articles by Jesper Møller Jensen
Based on 34 articles published since 2008
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Between 2008 and 2019, J. M. Jensen wrote the following 34 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Coronary CT Angiography Derived Fractional Flow Reserve: The Game Changer in Noninvasive Testing. 2017

Nørgaard, Bjarne Linde / Jensen, Jesper Møller / Blanke, Philipp / Sand, Niels Peter / Rabbat, Mark / Leipsic, Jonathon. ·Department Cardiology, Aarhus University Hospital, 8200, Aarhus N, Denmark. bnorgaard@dadlnet.dk. · Department Cardiology, Aarhus University Hospital, 8200, Aarhus N, Denmark. · Department of Radiology and Medicine, St. Paul´s Hospital, University of British Columbia, Vancouver, Canada. · Department Cardiology, Hospital of South West Denmark, Esbjerg, and Institute of regional Health Research, University of Southern Denmark, Esbjerg, Denmark. · Medicine and Radiology, Division of Cardiology, Loyola University Chicago, Chicago, Illinois, USA. ·Curr Cardiol Rep · Pubmed #28940026.

ABSTRACT: PURPOSE OF REVIEW: To summarize the scientific basis of CT derived fractional flow reserve (FFR

2 Review Interpreting results of coronary computed tomography angiography-derived fractional flow reserve in clinical practice. 2017

Rabbat, Mark G / Berman, Daniel S / Kern, Morton / Raff, Gilbert / Chinnaiyan, Kavitha / Koweek, Lynne / Shaw, Leslee J / Blanke, Philipp / Scherer, Markus / Jensen, Jesper M / Lesser, John / Nørgaard, Bjarne L / Pontone, Gianluca / De Bruyne, Bernard / Bax, Jeroen J / Leipsic, Jonathon. ·Department of Medicine and Radiology, Division of Cardiology, Loyola University Chicago, Chicago, IL, USA; Edward Hines Jr. Veteran's Affairs Hospital, Hines, IL, USA. Electronic address: mrabbat@lumc.edu. · Cedars-Sinai Medical Center, Department of Imaging, USA. · VA Long Beach HCS, Department of Cardiology, University of California Irvine, USA. · Beaumont Health, Department of Cardiology, USA. · Duke University, Department of Medicine and Radiology, USA. · Emory University, Department of Cardiology, USA. · St. Paul's Hospital & University of British Columbia, Department of Radiology, Canada. · Sanger Heart and Vascular Institute, Department of Cardiology, USA. · Aarhus University Hospital, Department of Cardiology, Denmark. · Minneapolis Heart Institute, USA. · Cardiologico Monzino, Department of Cardiovascular Imaging, Milan, Italy. · OLV Ziekenhuis Aalst, Cardiovascular Center Aalst, Belgium. · Leiden University Medical Center, Department of Cardiology, The Netherlands. ·J Cardiovasc Comput Tomogr · Pubmed #28666784.

ABSTRACT: The application of computational fluid dynamics to coronary computed tomography angiography allows Fractional Flow Reserve (FFR) to be calculated non-invasively (FFR

3 Review Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing? 2015

Nørgaard, B L / Jensen, J M / Leipsic, J. ·Department of Cardiology B, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark, bnorgaard@dadlnet.dk. ·Eur Radiol · Pubmed #25680721.

ABSTRACT: Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the "holy grail" in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFRCT). This review summarizes the clinical evidence for the use of FFRCT in stable CAD in context to the diagnostic performance of other non-invasive testing modalities. Key Points • The process of selecting appropriate patients for invasive coronary angiography is inadequate • Invasive fractional flow reserve is the standard for assessing coronary lesion-specific ischemia • Fractional flow reserve may be derived from standard coronary CT angiography (FFR CT ) • FFR CT provides high diagnostic performance in stable coronary artery disease.

4 Clinical Trial CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris. 2018

Øvrehus, Kristian A / Gaur, Sara / Leipsic, Jonathon / Jensen, Jesper M / Dey, Damini / Bøtker, Hans E / Ahmadi, Amir / Achenbach, Stephan / Ko, Brian / Nørgaard, Bjarne L. ·Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: kristian.altern.ovrehus@rsyd.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada. · Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Cardiology, Friedrich-Alexander University of Erlangen, Germany. · Monash Heart, Monash Medical Center and Monash University, Victoria, Australia. ·J Cardiovasc Comput Tomogr · Pubmed #29866619.

ABSTRACT: BACKGROUND: Coronary stenosis and plaque evaluation by coronary computed tomography angiography (CTA) may contribute to identify hemodynamically relevant lesions. We evaluated the most stenotic lesion including plaques proximal to it versus a total vessel analyses combined with stenosis for ischemia. METHODS: Patients scheduled for clinically indicated invasive coronary angiography (ICA) for suspected coronary artery disease underwent coronary CTA and ICA including fractional flow reserve (FFR) as part of the NXT trial (clinicaltrials.govNCT01757678). Stenoses were visually graded ≤50%, 51-70%, and >70% on coronary CTA. Semi-automated plaque analyses were performed using a proximal to the FFR pressure sensor location (including the most severe lesion to the coronary ostium) versus a total vessel (vessel diameter ≥2 mm) approach. Coronary stenosis and plaque parameters were evaluated for discrimination of ischemia by logistic regressions and combined models analyzed using receiver operating characteristics (ROC) with invasive FFR≤ 0.80 as reference standard. RESULTS: In 254 patients, mean (±SD) age 64 (±10) years, 64% male, a coronary CTA stenosis >50% was present in 239 (49%) vessels. Invasive FFR was ≤0.80 in 100 (21%) vessels. Coronary stenosis severity and low-density non-calcified plaque (LD-NCP) volume were independent predictors of ischemia in the "proximal" and "total-vessel" analyses. Stenosis severity + total vessel LD-NCP assessment performed better than stenosis severity + proximal LD-NCP evaluation (Area under curve [AUC] (95%CI): 0.83 (0.78-0.87) vs 0.81 (0.76-0.86), p-value = 0.009), whereas stenosis severity + proximal LD-NCP performed better than stenosis alone (AUC (95%CI): 0.81 (0.76-0.86) vs 0.78 (0.73-0.83), p-value = 0.019). CONCLUSION: Adding total vessel high-risk plaque volume to stenosis severity improves discrimination of ischemia in coronary CTA performed in patients with stable angina pectoris.

5 Clinical Trial Integrated prediction of lesion-specific ischaemia from quantitative coronary CT angiography using machine learning: a multicentre study. 2018

Dey, Damini / Gaur, Sara / Ovrehus, Kristian A / Slomka, Piotr J / Betancur, Julian / Goeller, Markus / Hell, Michaela M / Gransar, Heidi / Berman, Daniel S / Achenbach, Stephan / Botker, Hans Erik / Jensen, Jesper Moller / Lassen, Jens Flensted / Norgaard, Bjarne Linde. ·Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Taper building, A238, 8700 Beverly Blvd, Los Angeles, 90048, USA. Damini.Dey@cshs.org. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Taper building, A238, 8700 Beverly Blvd, Los Angeles, 90048, USA. · Department of Cardiology, Friedrich-Alexander Universitat Erlangen-Nurnberg, Erlangen, Germany. ·Eur Radiol · Pubmed #29352380.

ABSTRACT: OBJECTIVES: We aimed to investigate if lesion-specific ischaemia by invasive fractional flow reserve (FFR) can be predicted by an integrated machine learning (ML) ischaemia risk score from quantitative plaque measures from coronary computed tomography angiography (CTA). METHODS: In a multicentre trial of 254 patients, CTA and invasive coronary angiography were performed, with FFR in 484 vessels. CTA data sets were analysed by semi-automated software to quantify stenosis and non-calcified (NCP), low-density NCP (LD-NCP, < 30 HU), calcified and total plaque volumes, contrast density difference (CDD, maximum difference in luminal attenuation per unit area) and plaque length. ML integration included automated feature selection and model building from quantitative CTA with a boosted ensemble algorithm, and tenfold stratified cross-validation. RESULTS: Eighty patients had ischaemia by FFR (FFR ≤ 0.80) in 100 vessels. Information gain for predicting ischaemia was highest for CDD (0.172), followed by LD-NCP (0.125), NCP (0.097), and total plaque volumes (0.092). ML exhibited higher area-under-the-curve (0.84) than individual CTA measures, including stenosis (0.76), LD-NCP volume (0.77), total plaque volume (0.74) and pre-test likelihood of coronary artery disease (CAD) (0.63); p < 0.006. CONCLUSIONS: Integrated ML ischaemia risk score improved the prediction of lesion-specific ischaemia by invasive FFR, over stenosis, plaque measures and pre-test likelihood of CAD. KEY POINTS: • Integrated ischaemia risk score improved prediction of ischaemia over quantitative plaque measures • Integrated ischaemia risk score showed higher prediction of ischaemia than standard approach • Contrast density difference had the highest information gain to identify lesion-specific ischaemia.

6 Clinical Trial Effect of the ratio of coronary arterial lumen volume to left ventricle myocardial mass derived from coronary CT angiography on fractional flow reserve. 2017

Taylor, Charles A / Gaur, Sara / Leipsic, Jonathon / Achenbach, Stephan / Berman, Daniel S / Jensen, Jesper M / Dey, Damini / Bøtker, Hans Erik / Kim, Hyun Jin / Khem, Sophie / Wilk, Alan / Zarins, Christopher K / Bezerra, Hiram / Lesser, John / Ko, Brian / Narula, Jagat / Ahmadi, Amir / Øvrehus, Kristian A / St Goar, Fred / De Bruyne, Bernard / Nørgaard, Bjarne L. ·HeartFlow, Inc., Redwood City, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA. Electronic address: ctaylor@heartflow.com. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Radiology and Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. · Department of Cardiology, Erlangen, Germany. · Department of Cardiology, Cedars Sinai Hospital, Los Angeles, CA, USA. · HeartFlow, Inc., Redwood City, CA, USA. · Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland, Ohio, USA. · Minneapolis Heart Institute, Minneapolis, MN, USA. · Monash Heart, Monash Medical Center and Monash University, Victoria, Australia. · Department of Cardiology, Mount Sinai Hospital, New York, NY, USA. · Department of Cardiology, El Camino Hospital, Mountain View, CA, USA. · Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium. ·J Cardiovasc Comput Tomogr · Pubmed #28789941.

ABSTRACT: BACKGROUND: We hypothesize that in patients with suspected coronary artery disease (CAD), lower values of the ratio of total epicardial coronary arterial lumen volume to left ventricular myocardial mass (V/M) result in lower fractional flow reserve (FFR). METHODS: V/M was computed in 238 patients from the NXT trial who underwent coronary computed tomography angiography (CTA), quantitative coronary angiography (QCA) and FFR measurement in 438 vessels. Nitroglycerin was administered prior to CT, QCA and FFR acquisition. The V/M ratio was quantified on a patient-level from CT image data by segmenting the epicardial coronary arterial lumen volume (V) and the left ventricular myocardial mass (M). Calcified and noncalcified plaque volumes were quantified using semi-automated software. RESULTS: The median value of V/M (18.57 mm CONCLUSIONS: Patients with a low V/M ratio have lower FFR overall and in non-obstructive CAD, independent of plaque measures.

7 Clinical Trial Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography: PLATFORM. 2015

Hlatky, Mark A / De Bruyne, Bernard / Pontone, Gianluca / Patel, Manesh R / Norgaard, Bjarne L / Byrne, Robert A / Curzen, Nick / Purcell, Ian / Gutberlet, Matthias / Rioufol, Gilles / Hink, Ulrich / Schuchlenz, Herwig Walter / Feuchtner, Gudrun / Gilard, Martine / Andreini, Daniele / Jensen, Jesper M / Hadamitzky, Martin / Wilk, Alan / Wang, Furong / Rogers, Campbell / Douglas, Pamela S / Anonymous7530845. ·Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: hlatky@stanford.edu. · Cardiovascular Center Aalst, Aalst, Belgium. · Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. · Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. · Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark. · Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · University Hospital Southampton NHS Trust, Southampton, United Kingdom. · Freeman Hospital, Newcastle upon Tyne, United Kingdom. · University of Leipzig Heart Centre, Leipzig, Germany. · Hospices Civils de Lyon and Laboratoire de Recherche en Cardiovasculaire, Métabolisme, Diabétologie et Nutrition, Institut National de la Santé et de la Recherche Médicale, Lyon, France. · Cardiology Department, Johannes Gutenberg University Hospital, Mainz, Germany. · LKH Graz West, Graz, Austria. · Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. · Department of Cardiology, Cavale Blanche Hospital, Brest, France. · HeartFlow, Inc., Redwood City, California. ·J Am Coll Cardiol · Pubmed #26475205.

ABSTRACT: BACKGROUND: Fractional flow reserve estimated using computed tomography (FFRCT) might improve evaluation of patients with chest pain. OBJECTIVES: The authors sought to determine the effect on cost and quality of life (QOL) of using FFRCT instead of usual care to evaluate stable patients with symptoms suspicious for coronary disease. METHODS: Symptomatic patients without known coronary disease were enrolled into 2 strata based on whether invasive or noninvasive diagnostic testing was planned. In each stratum, consecutive observational cohorts were evaluated with either usual care or FFRCT. The number of diagnostic tests, invasive procedures, hospitalizations, and medications during 90-day follow-up were multiplied by U.S. cost weights and summed to derive total medical costs. Changes in QOL from baseline to 90 days were assessed using the Seattle Angina Questionnaire, the EuroQOL, and a visual analog scale. RESULTS: In the 584 patients, 74% had atypical angina, and the pre-test probability of coronary disease was 49%. In the planned invasive stratum, mean costs were 32% lower among the FFRCT patients than among the usual care patients ($7,343 vs. $10,734 p < 0.0001). In the noninvasive stratum, mean costs were not significantly different between the FFRCT patients and the usual care patients ($2,679 vs. $2,137; p = 0.26). In a sensitivity analysis, when the cost weight of FFRCT was set to 7 times that of computed tomography angiography, the FFRCT group still had lower costs than the usual care group in the invasive testing stratum ($8,619 vs. $ 10,734; p < 0.0001), whereas in the noninvasive testing stratum, when the cost weight of FFRCT was set to one-half that of computed tomography angiography, the FFRCT group had higher costs than the usual care group ($2,766 vs. $2,137; p = 0.02). Each QOL score improved in the overall study population (p < 0.0001). In the noninvasive stratum, QOL scores improved more in FFRCT patients than in usual care patients: Seattle Angina Questionnaire 19.5 versus 11.4, p = 0.003; EuroQOL 0.08 versus 0.03, p = 0.002; and visual analog scale 4.1 versus 2.3, p = 0.82. In the invasive cohort, the improvements in QOL were similar in the FFRCT and usual care patients. CONCLUSIONS: An evaluation strategy based on FFRCT was associated with less resource use and lower costs within 90 days than evaluation with invasive coronary angiography. Evaluation with FFRCT was associated with greater improvement in quality of life than evaluation with usual noninvasive testing. (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts [PLATFORM]; NCT01943903).

8 Clinical Trial Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial. 2015

Nørgaard, Bjarne L / Gaur, Sara / Leipsic, Jonathon / Ito, Hiroshi / Miyoshi, Toru / Park, Seung-Jung / Zvaigzne, Ligita / Tzemos, Nikolaos / Jensen, Jesper M / Hansson, Nicolaj / Ko, Brian / Bezerra, Hiram / Christiansen, Evald H / Kaltoft, Anne / Lassen, Jens F / Bøtker, Hans Erik / Achenbach, Stephan. ·Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Cardiology, Okayama University Hospital, Okayama, Japan. · Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. · Diagnostic Institute of Radiology, Paul Stradins Clinical University Hospital, Riga, Latvia. · Department of Radiology, Golden Jubilee Hospital, Glasgow, Scotland. · MonashHeart, Monash Medical Center and Monash University, Victoria, Australia. · Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio. · Department of Cardiology, Erlangen University Hospital, Erlangen, Germany. ·JACC Cardiovasc Imaging · Pubmed #26298072.

ABSTRACT: OBJECTIVES: The goal of this study was to examine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) in relation to coronary calcification severity. BACKGROUND: FFRCT has shown promising results in identifying lesion-specific ischemia. The extent to which the severity of coronary calcification affects the diagnostic performance of FFRCT is not known. METHODS: Coronary calcification was assessed by using the Agatston score (AS) in 214 patients suspected of having coronary artery disease who underwent coronary CTA, FFRCT, and FFR (FFR examination was performed in 333 vessels). The diagnostic performance of FFRCT (≤0.80) in identifying vessel-specific ischemia (FFR ≤0.80) was investigated across AS quartiles (Q1 to Q4) and for discrimination of ischemia in patients and vessels with a low-mid AS (Q1 to Q3) versus a high AS (Q4). Coronary CTA stenosis was defined as lumen reduction >50%. RESULTS: Mean ± SD per-patient and per-vessel AS were 302 ± 468 (range 0 to 3,599) and 95 ± 172 (range 0 to 1,703), respectively. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of FFRCT across AS quartiles. Discrimination of ischemia by FFRCT was high in patients with a high AS (416 to 3,599) and a low-mid AS (0 to 415), with no difference in area under the receiver-operating characteristic curve (AUC) (0.86 [95% confidence interval (CI): 0.76 to 0.96] vs. 0.92 [95% CI: 0.88 to 0.96]) (p = 0.45). Similarly, discrimination of ischemia by FFRCT was high in vessels with a high AS (121 to 1,703) and a low-mid AS (0 to 120) (AUC: 0.91 [95% CI: 0.85 to 0.97] vs. 0.95 [95% CI: 0.91 to 0.98]; p = 0.65). Diagnostic accuracy and specificity of FFRCT were significantly higher than for stenosis assessment in each AS quartile at the per-patient (p < 0.001) and per-vessel (p < 0.05) level with similar sensitivity. In vessels with a high AS, FFRCT exhibited improved discrimination of ischemia compared with coronary CTA alone (AUC: 0.91 vs. 0.71; p = 0.004), whereas on a per-patient level, the difference did not reach statistical significance (AUC: 0.86 vs. 0.72; p = 0.09). CONCLUSIONS: FFRCT provided high and superior diagnostic performance compared with coronary CTA interpretation alone in patients and vessels with a high AS.

9 Clinical Trial Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). 2014

Nørgaard, Bjarne L / Leipsic, Jonathon / Gaur, Sara / Seneviratne, Sujith / Ko, Brian S / Ito, Hiroshi / Jensen, Jesper M / Mauri, Laura / De Bruyne, Bernard / Bezerra, Hiram / Osawa, Kazuhiro / Marwan, Mohamed / Naber, Christoph / Erglis, Andrejs / Park, Seung-Jung / Christiansen, Evald H / Kaltoft, Anne / Lassen, Jens F / Bøtker, Hans Erik / Achenbach, Stephan / Anonymous4700783. ·Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · MonashHeart, Monash Medical Center and Monash University, Victoria, Australia. · Department of Cardiology, Okayama University Hospital, Okayama, Japan. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. · Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio. · Department of Cardiology, Erlangen University Hospital, Erlangen, Germany. · Department of Cardiology and Angiology, Elisabeth-Krankenhaus Essen, Essen, Germany. · Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia. · Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. ·J Am Coll Cardiol · Pubmed #24486266.

ABSTRACT: OBJECTIVES: The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR(CT)) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). BACKGROUND: FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFR(CT) to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. METHODS: This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFR(CT) was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFR(CT) or FFR ≤0.80. RESULTS: The area under the receiver-operating characteristic curve for FFR(CT) was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFR(CT) versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFR(CT) remained high. CONCLUSIONS: FFR(CT) provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA, FFR(CT) led to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678).

10 Clinical Trial Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography. 2012

Jensen, Jesper K / Medina, Hector M / Nørgaard, Bjarne L / Øvrehus, Kristian A / Jensen, Jesper M / Nielsen, Lene H / Maurovich-Horvat, Pal / Engel, Leif-Christopher / Januzzi, James L / Hoffmann, Udo / Truong, Quynh A. ·Department of Cardiology, Vejle Hospital, Denmark. jesperkjensen@dadlnet.dk ·Int J Cardiol · Pubmed #21543126.

ABSTRACT: BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac computed tomography angiography (CTA). METHODS: We analyzed the CTA in 392 patients with no history of CAD (24 patients with acute IS and 368 patients with acute chest pain). Extent of plaque burden was additionally dichotomized into 0-4 versus >4 segments. RESULTS: Patients with IS had a near 5-fold increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P<0.01) as compared to those without IS. After adjustment for age, gender, and traditional cardiac risk factors, there remained a near 4-fold increase odds for coronary plaque (adjusted OR 3.7, P=0.04). When stratified by extent of plaque, patients with IS had over 18-fold increase odds of having >4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P<0.01), which remained significantly associated in adjusted analysis (adjusted OR 12.1, P<0.001). CONCLUSION: Acute IS is independently associated with higher risk and greater extent of CAD compared to patients with acute chest pain at low-to-intermediate risk for acute coronary syndrome.

11 Article Myocardial Perfusion Imaging Versus Computed Tomography Angiography-Derived Fractional Flow Reserve Testing in Stable Patients With Intermediate-Range Coronary Lesions: Influence on Downstream Diagnostic Workflows and Invasive Angiography Findings. 2017

Nørgaard, Bjarne L / Gormsen, Lars C / Bøtker, Hans Erik / Parner, Erik / Nielsen, Lene H / Mathiassen, Ole N / Grove, Erik L / Øvrehus, Kristian A / Gaur, Sara / Leipsic, Jonathon / Pedersen, Kamilla / Terkelsen, Christian J / Christiansen, Evald H / Kaltoft, Anne / Mæng, Michael / Kristensen, Steen D / Krusell, Lars R / Lassen, Jens F / Jensen, Jesper M. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark bnorgaard@dadlnet.dk. · Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark. · Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. ·J Am Heart Assoc · Pubmed #28862968.

ABSTRACT: BACKGROUND: Data on the clinical utility of coronary computed tomography angiography-derived fractional flow reserve (FFR METHODS AND RESULTS: This was a single-center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFR CONCLUSIONS: Replacing adjunctive myocardial perfusion imaging with FFR

12 Article High burden of coronary atherosclerosis in patients with cirrhosis. 2017

Kazankov, Konstantin / Munk, Kim / Øvrehus, Kristian Altern / Jensen, Jesper Møller / Siggaard, Cecilie Brøckner / Grønbaek, Henning / Nørgaard, Bjarne Linde / Vilstrup, Hendrik. ·Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. ·Eur J Clin Invest · Pubmed #28657113.

ABSTRACT: BACKGROUND: Population studies report increased cardiovascular mortality in patients with cirrhosis. Coronary artery disease may be a trait of end-stage liver disease, but whether it is frequent or extensive in cirrhosis in general is unknown. Thus, we aimed to assess the prevalence and extent of coronary artery disease in unselected cirrhosis patients. MATERIALS AND METHODS: Using coronary computed tomography angiography, we investigated 52 patients from all Child-Pugh classes and aetiologies of cirrhosis without known cardiac disease for presence and severity of coronary artery disease in a cross-sectional design. Persons referred with new-onset chest pain served as controls. RESULTS: The prevalence of coronary artery disease was not significantly different between cirrhosis patients and controls (77% vs. 65%, P=0·19). However, cirrhosis patients had a markedly higher coronary artery calcification (Agatston) score than controls (120 [interquartile range, 0-345] vs. 5 [interquartile range, 0-86] HU, P=0·001). Likewise, patients with cirrhosis had a higher prevalence of extensive (≥5 coronary segments involved; 45% vs. 18%, P=0·01) and multivessel coronary disease (≥2 vessels involved; 75% vs. 53%, P=0·02). Furthermore, the total plaque volume whether noncalcified or calcified was higher in cirrhosis (117 [interquartile range, 0-310] vs. 36 [interquartile range, 0-148] mm CONCLUSION: Coronary artery disease is equally prevalent in patients with cirrhosis and subjects with new-onset chest pain, but cirrhosis patients have more extensive and severe disease including several coronary high-risk features associated with myocardial ischaemia and a poor clinical outcome. The potential of preventive measures for coronary artery disease in cirrhosis needs attention.

13 Article Increased high-risk coronary plaque burden is associated with arterial stiffness in patients with type 2 diabetes without clinical signs of coronary artery disease: a computed tomography angiography study. 2017

Funck, Kristian L / Laugesen, Esben / Øvrehus, Kristian / Jensen, Jesper M / Nørgaard, Bjarne L / Dey, Damini / Hansen, Troels K / Poulsen, Per L. ·aDepartment of Internal Medicine and Endocrinology, Aarhus University HospitalbDepartment of Clinical Medicine, Aarhus University, Aarhus CcThe Danish Diabetes Academy, OdensedDepartment of Cardiology, Aarhus University Hospital, Aarhus C, DenmarkeDepartment of Biomedical Sciences, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, California, USA. ·J Hypertens · Pubmed #28441695.

ABSTRACT: OBJECTIVES: Arterial stiffness and subclinical coronary atherosclerosis may yield valuable information on cardiovascular risk. We aimed to characterize coronary atherosclerosis in asymptomatic patients with type 2 diabetes and healthy controls and to investigate the association between baseline arterial stiffness and coronary plaque volumes after 5-year follow-up. METHODS: Data from 45 patients and 61 matched controls were available for coronary plaque assessment. For analysis including carotid-femoral pulse wave velocity (PWV), 43 patients and 55 controls were available. At follow-up, mean (SD) age of participants was 63 ± 10 years, and mean diabetes duration (SD) in the patient group was 7.8 ± 1.4 years. Arterial stiffness (PWV) was assessed by tonometry at both visits. Total, calcified, noncalcified, low-density noncalcified coronary plaques volumes and other plaque characteristics were assessed by coronary computed tomography angiography at follow-up. RESULTS: Despite of similar or better blood pressure and plasma lipid control, patients had, compared with controls, a higher number of plaques with spotty calcifications (P < 0.01) and remodeling index more than 1.1 (P < 0.05), larger calcified plaque volumes [patients vs. CONTROLS: 11 (0-65) vs. 3 (0-30) μl (P = 0.03)] and higher PWV [patients vs. controls at baseline: 9.1 ± 2.2 vs. 7.9 ± 1.4 m/s (P < 0.01), at follow-up: 9.3 ± 2.3 vs. 8.4 ± 1.8 m/s (P = 0.02)]. Baseline PWV was associated with volumes of all plaque types in crude analysis (P < 0.01) and with low-density noncalcified plaque volume in analysis adjusted for age, sex, diabetes and blood pressure (P = 0.01). CONCLUSION: Coronary plaques with unfavorable characteristics are more prevalent in well controlled asymptomatic patients with type 2 diabetes compared with healthy controls and independently associated with arterial stiffness.Clinical trials registration number: NCT02001532.

14 Article Coronary Plaque Burden and Adverse Plaque Characteristics Are Increased in Healthy Relatives of Patients With Early Onset Coronary Artery Disease. 2017

Christiansen, Morten K / Jensen, Jesper M / Nørgaard, Bjarne L / Dey, Damini / Bøtker, Hans Erik / Jensen, Henrik K. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: morten.christiansen@clin.au.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California. ·JACC Cardiovasc Imaging · Pubmed #28109934.

ABSTRACT: OBJECTIVES: This study characterized and quantified subclinical atherosclerosis by coronary computed tomography angiography (CTA) in first-degree relatives of patients with early onset coronary artery disease (CAD). BACKGROUND: A strong family history of CAD is an important risk factor for adverse cardiovascular events. Whether predisposed individuals suffer an increased burden of coronary atherosclerosis and adverse plaque features is not known. METHODS: We included 88 healthy middle-aged first-degree relatives from 59 families with early onset CAD. Participants were matched by age and sex with 88 control patients with atypical angina or nonanginal chest pain and no family history of CAD, referred for coronary CTA. A blinded analysis of plaque burden and composition was performed using semiautomated plaque quantification software. The relative differences between the median volumes or the odds ratios (OR) were compared between groups, using a mixed model. RESULTS: First-degree relatives had significantly more affected coronary segments than controls (0 segments: 30% vs. 49%, respectively; 1 to 2 segments: 27% vs. 32%, respectively; 3 to 4 segments: 18% vs. 6%, respectively; and ≥5 segments: 25% vs. 14%, respectively; p = 0.001). In a multivariate model, the relative differences of total plaque, total calcified plaque (CP), total noncalcified plaque (NCP), and total low-density NCP (LD-NCP) were 5.8 (95% confidence interval [CI]: 2.8 to 11.9), 2.6 (95% CI: 1.5 to 4.5), 5.8 (95% CI: 2.9 to 12.0), and 3.6 (95% CI: 2.1 to 6.1), respectively. The adjusted OR of any positive remodeling plaque or any LD-NCP plaque was 4.2 (95% CI: 1.2 to 14) and 4.2 (95% CI: 1.9 to 9.5), respectively. CONCLUSIONS: Healthy first-degree relatives of patients with early onset CAD have an increased coronary plaque burden compared with symptomatic patients. The plaques display characteristics associated with myocardial ischemia and adverse coronary events.

15 Article Fractional flow reserve derived from coronary computed tomography angiography: diagnostic performance in hypertensive and diabetic patients. 2017

Eftekhari, Ashkan / Min, James / Achenbach, Stephan / Marwan, Mohamed / Budoff, Matthew / Leipsic, Jonathon / Gaur, Sara / Jensen, Jesper Møller / Ko, Brian S / Christiansen, Evald Høj / Kaltoft, Anne / Bøtker, Hans Erik / Jensen, Jens Flensted / Nørgaard, Bjarne Linde. ·Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark. · Weill Cornell Medical College, Dalio Institute of Cardiovascular Imagaing, New York-Presbyterian Hospital, New York, NY, USA. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · Department of Medicine, Los Angeles Biomedical Research Center, Torrance, CA, USA. · Division of Cardiology, Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada. ·Eur Heart J Cardiovasc Imaging · Pubmed #28013282.

ABSTRACT: Aims: Fractional flow reserve (FFR) derived from coronary computed tomography (FFRCT) has high diagnostic performance in stable coronary artery disease (CAD). The diagnostic performance of FFRCT in patients with hypertension (HTN) and diabetes (DM), who are at risk of microvascular impairment, is not known. Methods and results: We analysed the diagnostic performance of FFRCT, in patients (vessels) with DM (n = 16), HTN (n = 186), DM + HTN (n = 58) vs. controls (n = 107) with or with suspected CAD. Patients (vessels) were further divided according to left ventricular mass index (LVMI) tertiles. Reference standard was invasively measured FFR ≤0.80. Per-patient diagnostic accuracy (95% CI) in control patients was 71.7% (61.6-81.8) vs. 79.3 (74.0-85.0) (P = 0.12), 75.0% (47.6-92.7) (P = 0.52), and 75.9% (62.8-86.1) (P = 0.39) in patients with HTN, DM, and HTM + DM, respectively. There was no difference in discrimination of ischaemia by FFRCT between groups. On a per-vessel level, there was no significant difference in diagnostic performance or discrimination of ischaemia by FFRCT between groups. There was a decline in both per-patient and -vessel diagnostic specificity of FFRCT in the upper LVMI tertile when compared with lower tertiles; however, discrimination of ischaemia by FFRCT was unaltered across LVMI tertiles. Conclusion: The diagnostic performance of FFRCT is independent of the presence of HTN and DM. FFRCT is a robust method in a broad stable CAD population, including patients at high risk for microvascular disease.

16 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.

17 Article FFR Derived From Coronary CT Angiography in Nonculprit Lesions of Patients With Recent STEMI. 2017

Gaur, Sara / Taylor, Charles A / Jensen, Jesper M / Bøtker, Hans Erik / Christiansen, Evald H / Kaltoft, Anne K / Holm, Niels R / Leipsic, Jonathon / Zarins, Christopher K / Achenbach, Stephan / Khem, Sophie / Wilk, Alan / Bezerra, Hiram G / Lassen, Jens F / Nørgaard, Bjarne L. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: saga@clin.au.dk. · HeartFlow, Inc., Redwood City, California; Department of Bioengineering, Stanford University, Stanford, California. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Radiology and Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. · HeartFlow, Inc., Redwood City, California; Department of Surgery, Stanford University, Stanford, California. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · HeartFlow, Inc., Redwood City, California. · Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, Case Medical Center, Cleveland, Ohio. ·JACC Cardiovasc Imaging · Pubmed #27743953.

ABSTRACT: OBJECTIVES: This study sought to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFR BACKGROUND: In patients with stable angina, FFR METHODS: Coronary CTA with calculation of FFR RESULTS: The study evaluated 124 nonculprit vessels from 60 patients. Accuracy, sensitivity, and specificity of FFR CONCLUSIONS: The diagnostic performance of FFR

18 Article Clinical Use of Coronary CTA-Derived FFR for Decision-Making in Stable CAD. 2017

Nørgaard, Bjarne L / Hjort, Jakob / Gaur, Sara / Hansson, Nicolaj / Bøtker, Hans Erik / Leipsic, Jonathon / Mathiassen, Ole N / Grove, Erik L / Pedersen, Kamilla / Christiansen, Evald H / Kaltoft, Anne / Gormsen, Lars C / Mæng, Michael / Terkelsen, Christian J / Kristensen, Steen D / Krusell, Lars R / Jensen, Jesper M. ·Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Radiology, St. Paul's Hospital, University of British Columbia, British Columbia, Canada. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark. · Department of Nuclear Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark. ·JACC Cardiovasc Imaging · Pubmed #27085447.

ABSTRACT: OBJECTIVES: The goal of this study was to assess the real-world clinical utility of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFR BACKGROUND: FFR METHODS: We reviewed the complete diagnostic work-up of nonemergent patients referred for coronary computed tomography angiography over a 12-month period at Aarhus University Hospital, Denmark, including all patients with new-onset chest pain with no known CAD and with intermediate-range coronary lesions (lumen reduction, 30% to 70%) referred for FFR RESULTS: Among 1,248 patients referred for computed tomography angiography, 189 patients (mean age 59 years; 59% male) were referred for FFR CONCLUSIONS: FFR

19 Article 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study. 2016

Douglas, Pamela S / De Bruyne, Bernard / Pontone, Gianluca / Patel, Manesh R / Norgaard, Bjarne L / Byrne, Robert A / Curzen, Nick / Purcell, Ian / Gutberlet, Matthias / Rioufol, Gilles / Hink, Ulrich / Schuchlenz, Herwig Walter / Feuchtner, Gudrun / Gilard, Martine / Andreini, Daniele / Jensen, Jesper M / Hadamitzky, Martin / Chiswell, Karen / Cyr, Derek / Wilk, Alan / Wang, Furong / Rogers, Campbell / Hlatky, Mark A / Anonymous6790876. ·Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: pamela.douglas@duke.edu. · Cardiovascular Centre Aalst, Aalst, Belgium. · Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy. · Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · University Hospital Southampton NHS Trust, Southampton, United Kingdom. · Freeman Hospital, Newcastle upon Tyne, United Kingdom. · University of Leipzig Heart Centre, Leipzig, Germany. · Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France. · Department of Cardiology, Johannes Gutenberg University Hospital, Mainz, Germany. · LKH Graz West, Graz, Austria. · Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. · Department of Cardiology, Cavale Blanche Hospital, Brest, France. · HeartFlow, Redwood City, California. · Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California. ·J Am Coll Cardiol · Pubmed #27470449.

ABSTRACT: BACKGROUND: Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFRCT) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown. OBJECTIVES: The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFRCT instead of usual care. METHODS: Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFRCT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) (death, myocardial infarction, unplanned revascularization), total medical costs, and QOL. RESULTS: Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, MACE events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFRCT ($8,127 vs. $12,145 usual care; p < 0.0001); in the planned noninvasive stratum, mean costs did not differ when using an FFRCT cost weight of zero ($3,049 FFRCT vs. $2,579; p = 0.82), but were higher when using an FFRCT cost weight equal to CTA. QOL scores improved overall at 1 year (p < 0.001), with similar improvements in both groups, apart from the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of 0.12 for FFRCT vs. 0.07 for usual care; p = 0.02). CONCLUSIONS: In patients with stable chest pain and planned invasive coronary angiography, care guided by CTA and selective FFRCT was associated with equivalent clinical outcomes and QOL, and lower costs, compared with usual care over 1-year follow-up. (The PLATFORM Study: Prospective LongitudinAl Trial of FFRct: Outcome and Resource IMpacts [PLATFORM]; NCT01943903).

20 Article Cardiovascular risk factor control is insufficient in young patients with coronary artery disease. 2016

Christiansen, Morten Krogh / Jensen, Jesper Møller / Brøndberg, Anders Krogh / Bøtker, Hans Erik / Jensen, Henrik Kjærulf. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. ·Vasc Health Risk Manag · Pubmed #27307744.

ABSTRACT: BACKGROUND: Control of cardiovascular risk factor is important in secondary prevention of coronary artery disease (CAD) but it is unknown whether treatment targets are achieved in young patients. We aimed to examine the prevalence and control of risk factors in this subset of patients. METHODS: We performed a cross-sectional, single-center study on patients with documented CAD before age 40. All patients treated between 2002 and 2014 were invited to participate at least 6 months after the last coronary intervention. We included 143 patients and recorded the family history of cardiovascular disease, physical activity level, smoking status, body mass index, waist circumference, blood pressure, cholesterol levels, metabolic status, and current medical therapy. Risk factor control and treatment targets were evaluated according to the shared guidelines from the European Society of Cardiology. RESULTS: The most common insufficiently controlled risk factors were overweight (113 [79.0%]), low-density lipoprotein cholesterol above target (77 [57.9%]), low physical activity level (78 [54.6%]), hypertriglyceridemia (67 [46.9%]), and current smoking (53 [37.1%]). Almost one-half of the patients fulfilled the criteria of metabolic syndrome. The median (interquartile range) number of uncontrolled modifiable risk factors was 2 (2;4) and only seven (4.9%) patients fulfilled all modifiable health measure targets. CONCLUSION: Among the youngest patients with CAD, there remains a potential to improve the cardiovascular risk profile.

21 Article Coronary calcification among 3477 asymptomatic and symptomatic individuals. 2016

Øvrehus, Kristian A / Jasinskiene, Jurgita / Sand, Niels P / Jensen, Jesper M / Munkholm, Henrik / Egstrup, Kenneth / Lambrecthsen, Jess / Mickley, Hans / Diederichsen, Axel C P. ·Department of Cardiology, Odense University Hospital, Denmark Department of Cardiology, Lillebaelt Hospital - Vejle, Denmark kristianovrehus@hotmail.com. · Department of Cardiology, Esbjerg Hospital, Denmark. · Department of Cardiology, Esbjerg Hospital, Denmark Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark. · Department of Cardiology, Aarhus University Hospital - Skejby, Denmark. · Department of Cardiology, Lillebaelt Hospital - Vejle, Denmark. · Department of Cardiology, Svendborg Hospital, Denmark. · Department of Cardiology, Odense University Hospital, Denmark. ·Eur J Prev Cardiol · Pubmed #25573955.

ABSTRACT: BACKGROUND: Coronary artery calcification (CAC) can be detected by cardiac computed tomography (CT), is associated to cardiovascular risk, and common in asymptomatic individuals and patients referred for cardiac CT. DESIGN: CAC was evaluated in asymptomatic individuals and symptomatic patients referred for cardiac CT, to assess whether differences in CAC may be explained by symptoms or traditional cardiovascular risk factors. METHODS: The presence and extent of CAC, gender, family history of coronary artery disease, hypertension, hyperlipidaemia, diabetes and tobacco were compared in 1220 asymptomatic individuals aged 49-61 years and 2257 age-matched symptomatic patients referred for cardiac CT with suspected coronary artery disease. RESULTS: Symptomatic individuals had a higher frequency of a family history of coronary artery disease (46% vs. 23%, p < 0.001), hypertension (38% vs. 21%, p < 0.001), hyperlipidaemia (42% vs. 12%, p < 0.001), a trend for more diabetes (6% vs. 5%, p = 0.05), but no significant difference was observed for the presence of CAC (Agatston > 0; 45% vs. 45%, p = 0.94) or severe calcifications (Agatston > 400; 6% vs. 5%, p = 0.36). In multivariate analyses age (odds ratio (OR) 1.09-1.18), male gender (OR 3.5-6.43), hypertension (OR 1.42-1.79), hyperlipidaemia (OR 1.86-2.09) and tobacco use (OR 1.83-2.01) were predictors for the presence and extent of CAC, whereas symptoms were not predictive for the presence of (Agatston > 0, OR 0.70 (0.59-0.83)), mild (Agatston ≥ 10; OR 0.85 (0.71-1.02)), moderate (Agatston ≥ 100; OR 0.99 (0.79-1.24)) or severe calcifications (Agatston ≥ 400; OR 0.93 (0.65-1.33)). CONCLUSION: No difference in the presence or severity of coronary calcifications was observed between asymptomatic and symptomatic middle-aged individuals. After adjusting for cardiovascular risk factors, symptoms were not predictive for the presence or extent of CAC.

22 Article Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study. 2015

Douglas, Pamela S / Pontone, Gianluca / Hlatky, Mark A / Patel, Manesh R / Norgaard, Bjarne L / Byrne, Robert A / Curzen, Nick / Purcell, Ian / Gutberlet, Matthias / Rioufol, Gilles / Hink, Ulrich / Schuchlenz, Herwig Walter / Feuchtner, Gudrun / Gilard, Martine / Andreini, Daniele / Jensen, Jesper M / Hadamitzky, Martin / Chiswell, Karen / Cyr, Derek / Wilk, Alan / Wang, Furong / Rogers, Campbell / De Bruyne, Bernard / Anonymous3760841. ·Duke Clinical Research Institute, Duke University School of Medicine, 7022 North Pavilion DUMC, PO Box 17969, Durham, NC 27715, USA pamela.douglas@duke.edu. · Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy. · Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA. · Duke Clinical Research Institute, Duke University School of Medicine, 7022 North Pavilion DUMC, PO Box 17969, Durham, NC 27715, USA. · Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark. · Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · University Hospital Southampton NHS Trust, Southampton, UK. · Freeman Hospital, Newcastle upon Tyne, UK. · University of Leipzig Heart Centre, Leipzig, Germany. · Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France. · Department of Cardiology, Johannes Gutenberg University Hospital, Mainz, Germany. · LKH Graz West, Graz, Austria. · Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. · Department of Cardiology, Cavale Blanche Hospital, Brest, France. · HeartFlow, Redwood City, CA, USA. · Cardiovascular Centre Aalst, Aalst, Belgium. ·Eur Heart J · Pubmed #26330417.

ABSTRACT: AIMS: In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. METHODS AND RESULTS: At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFR(CT) (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFR(CT)-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFR(CT) arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53-69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFR(CT) results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFR(CT)) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFR(CT) arms. CONCLUSIONS: Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD.

23 Article A "normal" invasive coronary angiogram may not be normal. 2015

Nørgaard, Bjarne L / Hansson, Nicolaj C / Christiansen, Evald H / Kaltoft, Anne / Bøtker, Hans Erik / Lassen, Jens F / Mæng, Michael / Jensen, Jesper M. ·Department of Cardiology, Aarhus University Hospital Skejby, Skejby, Aarhus N, Aarhus DK-8200, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Department of Cardiology, Aarhus University Hospital Skejby, Skejby, Aarhus N, Aarhus DK-8200, Denmark. ·J Cardiovasc Comput Tomogr · Pubmed #26088376.

ABSTRACT: In clinical practice, a normal or near-normal invasive coronary angiogram is considered to be reliable evidence for the absence of hemodynamically significant coronary artery disease. We present 2 patients with near-normal coronary angiograms who had noninvasive evidence of vessel-specific ischemia confirmed by invasive measurement of fractional flow reserve.

24 Article Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines. 2015

Diederichsen, Axel C P / Mahabadi, Amir-Abbas / Gerke, Oke / Lehmann, Nils / Sand, Niels P / Moebus, Susanne / Lambrechtsen, Jess / Kälsch, Hagen / Jensen, Jesper M / Jöckel, Karl-Heinz / Mickley, Hans / Erbel, Raimund. ·Department of Cardiology, Odense University Hospital, Denmark. Electronic address: axel.diederichsen@rsyd.dk. · Department of Cardiology, West-German Heart Centre, University Hospital of Essen, Germany. · Department of Nuclear Medicine, Odense University Hospital, Denmark; Centre of Health Economics Research, University of Southern Denmark, Denmark. · Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany. · Department of Cardiology, Sydvestjysk Hospital, Denmark. · Department of Cardiology, Svendborg Hospital, Denmark. · Department of Cardiology, Aarhus University Hospital-Skejby, Denmark. · Department of Cardiology, Odense University Hospital, Denmark. ·Atherosclerosis · Pubmed #25602856.

ABSTRACT: OBJECTIVES: The European HeartScore has traditionally differentiated between low and high-risk countries. Until 2012 Germany and Denmark were considered to be high-risk countries but have now been defined as low-risk countries. In this survey we aim to address the consequences of this downgrading. METHODS: A screening of 3932 randomly selected (mean age 56 years, 46% male) individuals from Germany and Denmark free of cardiovascular disease was performed. Traditional risk factors were determined, and the HeartScore was measured using both the low-risk and the high-risk country models. A non-contrast Cardiac-CT scan was performed to detect coronary artery calcification (CAC). RESULTS: Agreement of HeartScore risk groups with CAC groups was poor, but higher when applying the algorithm for the low-risk compared to the high-risk country model (agreement rate: 77% versus 63%, and weighted Kappa: 0.22 versus 0.15). However, the number of subjects with severe coronary calcification (CAC score ≥400) increased in the low and intermediate HeartScore risk group from 78 to 147 participants (from 2.7 % to 4.2 %, p = 0.001), when estimating the risk based on the algorithm for low-risk countries. CONCLUSION: As a consequence of the reclassification of Germany and Denmark as low-risk countries more people with severe atherosclerosis will be classified as having a low or intermediate risk of fatal cardiovascular disease.

25 Article Fractional flow reserve derived from coronary CT angiography: variation of repeated analyses. 2014

Gaur, Sara / Bezerra, Hiram G / Lassen, Jens F / Christiansen, Evald H / Tanaka, Kentaro / Jensen, Jesper M / Oldroyd, Keith G / Leipsic, Jonathon / Achenbach, Stephan / Kaltoft, Anne K / Bøtker, Hans Erik / Nørgaard, Bjarne L. ·Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby, 8200 Aarhus N, Denmark. Electronic address: sargau@rm.dk. · Harrington Heart and Vascular Institute, Case Medical Center, Cleveland, OH, USA. · Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby, 8200 Aarhus N, Denmark. · Department of Cardiology, Golden Jubilee National Hospital, Glasgow, Scotland. · Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada. · Department of Cardiology, University of Erlangen, Erlangen, Germany. ·J Cardiovasc Comput Tomogr · Pubmed #25151923.

ABSTRACT: BACKGROUND: Fractional flow reserve (FFR) is the standard of reference for assessing the hemodynamic significance of coronary stenoses in patients with stable coronary artery disease. Noninvasive FFR derived from coronary CT angiography (FFRCT) is a promising new noninvasive method for assessing the physiologic significance of epicardial stenoses. The reproducibility of FFRCT has not yet been established. OBJECTIVE: The aim of this study was to evaluate the variation of repeated analyses of FFRCT per se and in the context of the reproducibility of repeated FFR measurements. METHODS: Coronary CT angiography and invasive coronary angiography with repeated FFR measurements were performed in 28 patients (58 vessels) with suspected stable coronary artery disease. Based on the coronary CT angiography data set, FFRCT analyses were performed twice by 2 independent blinded analysts. RESULTS: In 12 of 58 (21%) vessels FFR was ≤ 0.80. The standard deviation for the difference between first and second FFRCT analyses was 0.034 vs 0.033 for FFR repeated measurements (P = .722). Limits of agreement were -0.06 to 0.08 for FFRCT and -0.07 to 0.06 for FFR. The coefficient of variation of FFRCT (CVFFRct) was 3.4% (95% confidence interval [CI], 1.4%-4.6%) vs 2.7% (95% CI, 1.8%-3.3%) for FFR. In vessels with mean FFR ranging between 0.70 and 0.90 (n = 25), the difference between the first and second FFRCT analyses was 0.035 and FFR repeated measurements was 0.043 (P = .357), whereas CVFFRct was 3.3% (95% CI, 1.5%-4.3%) and coefficient of variation for FFR was 3.6% (95% CI, 2.3%-4.6%). CONCLUSIONS: The reproducibility of both repeated FFRCT analyses and repeated FFR measurements is high.

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