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Coronary Artery Disease: HELP
Articles by Jess Lambrechtsen
Based on 18 articles published since 2010
(Why 18 articles?)
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Between 2010 and 2020, J. Lambrechtsen wrote the following 18 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Clinical Trial Can osteoprotegerin be used to identify the presence and severity of coronary artery disease in different clinical settings? 2014

Hosbond, Susanne Elisabeth / Diederichsen, Axel Cosmus Pyndt / Saaby, Lotte / Rasmussen, Lars Melholt / Lambrechtsen, Jess / Munkholm, Henrik / Sand, Niels Peter Rønnow / Gerke, Oke / Poulsen, Tina Svenstrup / Mickley, Hans. ·Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. Electronic address: susanne.hosbond@rsyd.dk. · Department of Cardiology, Odense University Hospital, Odense, Denmark; Centre for Individualized Medicine of Arterial Diseases, Odense University Hospital, Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. · Department of Biochemistry and Pharmacology, Odense University Hospital, Denmark; Centre for Individualized Medicine of Arterial Diseases, Odense University Hospital, Denmark. · Department of Cardiology, Odense University Hospital, Svendborg, Denmark. · Department of Cardiology, Lillebaelt Hospital, Vejle Hospital, Denmark. · Department of Cardiology, Hospital of South West Denmark, Esbjerg, Denmark; Institute of Regional Health Services Research, University of Southern Denmark, Denmark. · Department of Nuclear Medicine, Odense University Hospital, Denmark; Centre of Health Economics Research, University of Southern Denmark, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. ·Atherosclerosis · Pubmed #25104079.

ABSTRACT: PURPOSE: The biomarker Osteoprotegerin (OPG) is associated with coronary artery disease (CAD). The main purpose of this study was to evaluate the diagnostic value of OPG in healthy subjects and in patients with suspected angina pectoris (AP). METHODS: A total of 1805 persons were enrolled: 1152 healthy subjects and 493 patients with suspected AP. For comparison 160 patients with acute myocardial infarction (MI) were included. To uncover subclinical coronary atherosclerosis, a non-contrast cardiac-CT scan was performed in healthy subjects; while in patients with suspected AP a contrast coronary angiography was used to detect significant stenosis. OPG concentrations were analyzed and compared between groups. ROC-analyses were performed to estimate OPG cut-off values. RESULTS: OPG concentrations increased according to disease severity with the highest levels found in patients with acute MI. No significant difference (p = 0.97) in OPG concentrations was observed between subgroups of healthy subjects according to severity of coronary calcifications. A significant difference (p < 0.0001) in OPG concentrations was found between subgroups of patients with suspected stable AP according to severity of CAD. ROC-analysis showed an AUC of 0.62 (95% CI: 0.57-0.67). The optimal cut-off value of OPG (<2.29 ng/mL) had a sensitivity of 56.2% (95% CI: 49.2-63.0%) and a specificity of 62.9% (95% CI: 57.3-68.2%). CONCLUSION: OPG cannot be used to differentiate between healthy subjects with low versus high levels of coronary calcifications. In patients with suspected AP a single OPG measurement is of limited use in the diagnosis of CAD.

2 Article Coronary artery disease risk reclassification by a new acoustic-based score. 2019

Schmidt, S E / Winther, S / Larsen, B S / Groenhoej, M H / Nissen, L / Westra, J / Frost, L / Holm, N R / Mickley, H / Steffensen, F H / Lambrechtsen, J / Nørskov, M S / Struijk, J J / Diederichsen, A C P / Boettcher, M. ·Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark. sschmidt@hst.aau.dk. · Department of Cardiology, Region Hospital Herning, Herning, Denmark. · Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark. · Acarix, Lyngby, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark. · Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark. · Department of Cardiology, Svendborg Hospital, Svendborg, Denmark. ·Int J Cardiovasc Imaging · Pubmed #31273633.

ABSTRACT: To determine the potential of a non-invasive acoustic device (CADScor®System) to reclassify patients with intermediate pre-test probability (PTP) and clinically suspected stable coronary artery disease (CAD) into a low probability group thereby ruling out significant CAD. Audio recordings and clinical data from three studies were collected in a single database. In all studies, patients with a coronary CT angiography indicating CAD were referred to coronary angiography. Audio recordings of heart sounds were processed to construct a CAD-score. PTP was calculated using the updated Diamond-Forrester score and patients were classified according to the current ESC guidelines for stable CAD: low < 15%, intermediate 15-85% and high > 85% PTP. Intermediate PTP patients were re-classified to low probability if the CAD-score was ≤ 20. Of 2245 patients, 212 (9.4%) had significant CAD confirmed by coronary angiography ( ≥ 50% diameter stenosis). The average CAD-score was higher in patients with significant CAD (38.4 ± 13.9) compared to the remaining patients (25.1 ± 13.8; p < 0.001). The reclassification increased the proportion of low PTP patients from 13.6% to 41.8%, reducing the proportion of intermediate PTP patients from 83.4% to 55.2%. Before reclassification 7 (3.1%) low PTP patients had CAD, whereas post-reclassification this number increased to 28 (4.0%) (p = 0.52). The net reclassification index was 0.209. Utilization of a low-cost acoustic device in patients with intermediate PTP could potentially reduce the number of patients referred for further testing, without a significant increase in the false negative rate, and thus improve the cost-effectiveness for patients with suspected stable CAD.

3 Article Functional and Anatomical Testing in Intermediate Risk Chest Pain Patients with a High Coronary Calcium Score: Rationale and Design of the FACC Study. 2019

Øvrehus, Kristian A / Veien, Karsten T / Lambrechtsen, Jess / Rohold, Allan / Steffensen, Flemming H / Gerke, Oke / Jensen, Lisette O / Mickley, Hans. ·Odense University Hospital Department of Cardiology, Odense, Denmark. · Svendborg Hospital Department of Cardiology, Svendborg, Denmark. · Esbjerg Hospital Department of Cardiology, Esbjerg, Denmark. · Vejle Hospital Department of Cardiology, Vejle, Denmark. · Odense University Hospital Department of Cardiology, Odense, Denmark, Hans.mickley@rsyd.dk. ·Cardiology · Pubmed #31170719.

ABSTRACT: Current guidelines do not recommend coronary computed tomography angiography (CCTA) in patients with high levels of coronary calcium, as severe calcification leads to difficulties in estimating stenosis severity due to blooming artifacts obscuring the vessel lumen. Whether the CCTA-derived fractional flow reserve (FFRCT) improves the diagnostic performance of CCTA in patients with high levels of coronary calcification has not been sufficiently evaluated. We hypothesize that a noninvasive diagnostic strategy using FFRCT will perform comparably to an invasive diagnostic strategy in the detection of hemodynamically significant coronary artery disease (CAD) in clinical stable chest pain patients with high levels of coronary calcium. In this prospective, blinded, multicenter study, patients with suspected stable CAD referred for CCTA and demonstrating an Agatston score >399 will be included. Patients accepting inclusion will, in addition to CCTA, undergo invasive coronary angiography (ICA) and invasive FFR measurement. FFRCT analyses are performed by an external core laboratory blinded to any patient data, and the FFRCT results are blinded to all participating study sites. The primary objective is to evaluate whether FFRCT can identify patients with and without hemodynamically significant CAD, when ICA with FFR is the reference standard. A negative study result would question the clinical usefulness of FFRCT in patients with high levels of coronary calcium. A positive study result, however, would imply a reduction in the number of patients referred for coronary catheterization and, at the same time, increase the proportion of patients with hemodynamically significant CAD at the subsequent invasive examination.

4 Article A novel alignment procedure to assess calcified coronary plaques in histopathology, post-mortem computed tomography angiography and optical coherence tomography. 2019

Precht, Helle / Broersen, Alexander / Kitslaar, Pieter H / Dijkstra, Jouke / Gerke, Oke / Thygesen, Jesper / Egstrup, Kenneth / Leth, Peter Mygind / Hardt-Madsen, Michael / Nielsen, Bjarne / Falk, Erling / Lambrechtsen, Jess. ·Department of Medical Research, Odense University Hospital Svendborg, Valdemarsgade, 53, Svendborg, Denmark; Conrad Research Center, University College Lillebelt, Niels Bohrs Allé 1, 5230 Odense M, Denmark. Electronic address: hepr@ucl.dk. · Department of Radiology, Division of Image Processing, Leiden University Medical Center, Albinusdreef 2, 2300, RC, Leiden, The Netherlands. · Department of Radiology, Division of Image Processing, Leiden University Medical Center, Albinusdreef 2, 2300, RC, Leiden, The Netherlands; Medis Medical Imaging Systems bv, Schuttersveld 9, 2300, AJ, Leiden, The Netherlands. · Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard, 29, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, , Winsløwparken 19, 5000 Odense C, Denmark. · Department of Clinical Engineering, Central Denmark Region, Olof Palmes Allé 15, Århus N, Denmark. · Department of Medical Research, Odense University Hospital Svendborg, Valdemarsgade, 53, Svendborg, Denmark. · University of Southern Denmark, Institute of Forensic Medicine, J.B. Winsløws Vej 17B, 5000 Odense C, Denmark. · Odense University Hospital Svendborg, Department of Clinical Pathology, Valdemarsgade 53, 5700 Svendborg, Denmark. · Odense University Hospital, Department of Pathology, Sdr. Boulevard, 29, Odense C, Denmark. · Aarhus University Hospital Skejby, Department of Cardiology, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. ·Cardiovasc Pathol · Pubmed #30597423.

ABSTRACT: PURPOSE: Improve mapping and registration of longitudinal view on histopathology vessels in a three-dimensional alignment procedure for postmortem quantitative coronary plaque analyses. This new procedure is applied and results shown using calcified coronary plaque analyses within post-mortem computed tomography angiography (PMCTA), optical coherence tomography (OCT) and the gold standard of histopathology. RESULTS: In total, 338 annotated histopathology images were included, 166 PMCTA transversal images and 285 OCT images were aligned in the comparison. The results from the comparison using the alignment procedure showed overall that the calcified plaques seem to be overestimated by PMCTA and underestimated by OCT. CONCLUSIONS: The 3D fusion approach, aligning the images of PMCTA, OCT and histopathology as gold standard allowed for a slice-based comparison of the different modalities. The results showed that PMCTA overestimates the calcified plaques while OCT underestimates these, compared to histopathology.

5 Article External validity of a cardiovascular screening including a coronary artery calcium examination in middle-aged individuals from the general population. 2018

Grønhøj, Mette H / Gerke, Oke / Mickley, Hans / Steffensen, Flemming H / Lambrechtsen, Jess / Sand, Niels Peter R / Rasmussen, Lars M / Olsen, Michael H / Hallas, Jesper / Diederichsen, Axel Cp. ·1 Department of Cardiology, Odense University Hospital, Denmark. · 2 Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark. · 3 Department of Nuclear Medicine, Odense University Hospital, Denmark. · 4 Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark. · 5 Department of Cardiology, Vejle Hospital, Denmark. · 6 Department of Cardiology, Svendborg Hospital, Denmark. · 7 Department of Cardiology, Hospital of South West Denmark, Esbjerg, Denmark. · 8 Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark. · 9 Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark. · 10 Cardiology Section, Department of Internal Medicine, Holbæk Hospital, Denmark. · 11 Department of Clinical Pharmacology, Odense University Hospital, Denmark. ·Eur J Prev Cardiol · Pubmed #29719966.

ABSTRACT: Background Coronary artery calcium is important in cardiovascular risk stratification, but this knowledge is based on studies with a significant selection bias. This study aims to evaluate the external validity of a screening programme including coronary artery calcium examination, and the association between coronary artery calcium and cardiovascular events. Design Multi-centre population based study. Methods Randomly selected middle-aged men and women ( N = 1751) free of cardiovascular disease were invited to the examination during 2009-2010. Participation rate in the examination was 70%. Participants ( n = 1227) and non-participants ( n = 524) were compared regarding: cardiovascular medical treatment, Charlson comorbidity index and socioeconomic status (evaluated by cohabitation, gross income and education). Study endpoints were cardiovascular events and mortality. Results Non-participants had a significant higher comorbidity ( p = 0.003) and a lower socioeconomic status ( p < 0.0001), while cardiovascular medical treatment was alike. Over a median follow-up time of 6.5 years the cardiovascular event and mortality rates were equal (6.7% vs. 6.4%, p = 0.80 and 0.4% vs. 0.5%, p = 0.76, respectively). Adjusted hazard ratio was 0.90 (95% confidence interval (CI) 0.63-1.37). Among participants, the extent of coronary artery calcium was significantly associated with increased risk of cardiovascular events (hazard ratio 1.92, 95% CI 1.03-3.54, hazard ratio 3.66, 95% CI 1.82-7.32, hazard ratio 6.51, 95% CI 3.17-13.36 for coronary artery calcium scores 1-99, 100-399, ≥400 AU, respectively). Conclusions Non-participants had a higher comorbidity index and a lower socioeconomic status, but the cardiovascular event and mortality rates were equal to those of participants. Thus, a screening programme including a coronary artery calcium examination had a high external validity regarding cardiovascular risk, but also a significant social imbalance.

6 Article Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: a prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints. 2018

Ilangkovan, Nivethitha / Mogensen, Christian Backer / Mickley, Hans / Lassen, Annmarie Touborg / Lambrechtsen, Jess / Sand, Niels Peter Ronnow / Albiniussen, Rasmus / Byg, Jørgen / Steffensen, Flemming Hald / Grønhøj, Mette Hjortdal / Diederichsen, Axel. ·Cardiology Department, Hospital of Southern Denmark, Aabenraa, Denmark. · Emergency Department, Hospital of Southern Denmark, Aabenraa, Denmark. · Cardiology Department, Odense University Hospital, Odense, Denmark. · Emergency Department, Odense University Hospital, Odense, Denmark. · Medical Department, Svendborg Hospital, Svendborg, Denmark. · Cardiology Department, Esbjerg Hiospital, Esbjerg, Denmark. · Cardiology Department, Vejle Hospital, Vejle, Denmark. ·BMJ Open · Pubmed #29502085.

ABSTRACT: OBJECTIVES: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. DESIGN: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up. SETTING: Emergency and cardiology departments in the Region of Southern Denmark. SUBJECTS: In total, 229 patients with NSCP were compared with 722 patients from a background comparator population. MAIN OUTCOMES MEASURES: Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact. RESULTS: There was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death. CONCLUSION: The prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP. TRIAL REGISTRATION NUMBER: NCT02422316; Pre-results.

7 Article The association between uric acid levels and different clinical manifestations of coronary artery disease. 2018

Larsen, Trine R / Gerke, Oke / Diederichsen, Axel C P / Lambrechtsen, Jess / Steffensen, Flemming H / Sand, Niels P / Saaby, Lotte / Antonsen, Steen / Mickley, Hans. ·Departments of Clinical Biochemistry. · Departments of Nuclear Medicine. · Department of Business and Economics, Centre of Health Economics Research. · Cardiology, Odense University Hospital, Odense C. · Cardiology, Svendborg Hospital, Svendborg. · Department of Cardiology, Lillebaelt Hospital, Vejle. · Department of Regional Health Research, Institute of Regional Health Research, University of Southern Denmark, Odense M. · Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark. ·Coron Artery Dis · Pubmed #29194090.

ABSTRACT: AIMS: Uric acid (UA) has been associated with the presence and severity of coronary artery disease. To further assess the role of UA role in coronary artery disease, we investigated UA levels in both healthy asymptomatic middle-aged individuals and in different subgroups of hospitalized patients with suspected or definite myocardial infarction (MI). PATIENTS AND METHODS: The severity of coronary artery calcification (CAC) was examined in asymptomatic individuals (n=1039) using a noncontrast computed tomography scan. Hospitalized patients with suspected acute MI (n=772) were grouped according to troponin I (TnI) concentrations: (i) elevated TnI concentrations (>0.03 µg/l) with subdivision according to the type of MI and other clinical conditions associated with myocardial injury, or (ii) nonelevated TnI concentrations (≤0.03 µg/l). RESULTS: UA was not associated with the severity of CAC in asymptomatic individuals when adjusting for relevant risk factors. Patients with type 2 MI and patients with myocardial injury associated with conditions of myocardial ischemia showed significantly higher UA levels (0.390 mmol/l, P=0.002 and 0.400 mmol/l, P=0.001, respectively) than patients with type 1 MI (0.329 mmol/l), after adjusting for other risk factors. CONCLUSION: UA was not correlated with the severity of CAC in asymptomatic middle-aged individuals, and patients with type 2 MI or ischemic myocardial injury were shown to have higher UA levels than type 1 MI patients. This observation is concordant with the hypothesis that UA might be involved in the pathophysiological mechanisms leading to an imbalance in the oxygen supply/demand ratio in type 2 MI and ischemic myocardial injury.

8 Article CT-Detected Growth of Coronary Artery Calcification in Asymptomatic Middle-Aged Subjects and Association With 15 Biomarkers. 2017

Diederichsen, Søren Zöga / Grønhøj, Mette Hjortdal / Mickley, Hans / Gerke, Oke / Steffensen, Flemming Hald / Lambrechtsen, Jess / Rønnow Sand, Niels Peter / Rasmussen, Lars Melholt / Olsen, Michael Hecht / Diederichsen, Axel. ·Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej, Copenhagen, Denmark. Electronic address: Soeren.Zoega.Diederichsen@regionh.dk. · Department of Cardiology, Odense University Hospital, Odense, Denmark; Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark. · Department of Cardiology, Sygehus Lillebælt Vejle, Vejle, Denmark. · Department of Cardiology, Svendborg Hospital, Svendborg, Denmark. · Department of Cardiology, Hospital of South West Denmark, Esbjerg, Denmark; Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark. · Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark; Cardiovascular Centre of Excellence, University of Southern Denmark, Odense, Denmark. · Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark; Cardiovascular Centre of Excellence, University of Southern Denmark, Odense, Denmark; Cardiology Section, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark; Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark; Cardiovascular Centre of Excellence, University of Southern Denmark, Odense, Denmark. ·JACC Cardiovasc Imaging · Pubmed #28797406.

ABSTRACT: OBJECTIVES: This study sought to determine the incidence and progression of coronary artery calcification (CAC) in asymptomatic middle-aged subjects and to evaluate the value of a broad panel of biomarkers in the prediction of CAC growth. BACKGROUND: CAC continues to be a major risk factor, but the value of biochemical markers in predicting CAC incidence and progression remains unresolved. METHODS: At baseline, 1,227 men and women underwent traditional risk assessment and a computed tomography (CT) scan to determine the CAC score. Biomarkers of calcium-phosphate metabolism (calcium, phosphate, vitamin D RESULTS: A total of 1,006 participants underwent a CT scan after 5 years. Among the 562 participants with a baseline CAC score of 0, 189 (34%) had incident CAC, whereas 214 (48%) of the 444 participants with baseline CAC score >0 had significant progression (>15% annual increase in CAC score). In the multivariate models (n = 1,006), age, sex, hypertension, diabetes, dyslipidemia, and smoking were associated with ΔCAC, whereas the strongest predictor was baseline CAC score. Low-density lipoprotein and total cholesterol levels were independently associated with CAC incidence (n = 562; incidence rate ratio [IRR]: 1.47; 95% confidence interval [CI]: 1.05 to 2.05; and IRR: 1.34; 95% CI: 1.01 to 1.77, respectively), whereas phosphate level was associated with CAC progression (n = 444; IRR: 3.60; 95% CI: 1.42 to 9.11). CONCLUSIONS: In this prospective study, a large part of participants had incident CAC or progression of prevalent CAC at 5 years of follow-up. Low-density lipoprotein and total cholesterol were associated with CAC incidence and phosphate with CAC progression, whereas 12 other biomarkers had little value.

9 Article Lack of association between cystatin C and different coronary atherosclerotic manifestations. 2017

Larsen, Trine R / Gerke, Oke / Diederichsen, Axel C P / Lambrechtsen, Jess / Steffensen, Flemming Hald / Sand, Niels Peter / Antonsen, Steen / Mickley, Hans. ·a Department of Clinical Biochemistry , Svendborg Hospital , Svendborg , Denmark. · b Department of Nuclear Medicine , Odense University Hospital , Odense C , Denmark. · c Centre of Health Economics Research , University of Southern Denmark , Odense M , Denmark. · d Department of Cardiology , Odense University Hospital , Odense C , Denmark. · e Department of Cardiology , Svendborg Hospital , Svendborg , Denmark. · f Department of Cardiology , Lillebaelt Hospital , Vejle , Denmark. · g Department of Cardiology , Hospital of Southwest Denmark , Esbjerg , Denmark. · h Institute of Regional Health Research, University of Southern Denmark , Odense M , Denmark. ·Scand J Clin Lab Invest · Pubmed #28749732.

ABSTRACT: Cystatin C (CysC) is known to be related to cardiovascular disease (CVD), including the presence and severity of coronary artery disease (CAD) and future clinical events. In this study, the association between CysC levels and (1) coronary artery calcification (CAC) in asymptomatic individuals from the general population as well as (2) different subgroups of patients with suspected or definite acute myocardial infarction (MI) was investigated. CysC levels were measured in serum from asymptomatic individuals as part of a screening study for CAC using non-contrast cardiac CT scan (N = 1039) as well as in subgroups of hospitalized patients with a suspected MI (N = 769). CysC was not associated with CAC in asymptomatic individuals after adjusting for relevant risk factors. No difference in CysC levels was observed between patients with type 1 MI (1.07 mg/L) and patients with normal troponin (with or without prior CAD: 1.14 and 1.01 mg/L, respectively). However, patients with type 2 MI and patient subgroups with elevated troponin but without MI had significantly higher CysC levels (1.24, 1.23 and 1.31 mg/L), even after adjusting for other risk factors. CysC was not associated with CAC in middle-aged asymptomatic individuals from the general population. Furthermore, CysC levels were found to be significantly lower in patients with type 1 MI compared to patients with type 2 MI and patients with elevated troponins but without MI. Thus, in two independent and clinically different populations, no association between CysC and coronary atherosclerotic manifestations could be demonstrated.

10 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.

11 Article Impact of a motion correction algorithm on image quality in patients undergoing CT angiography: A randomized controlled trial. 2017

Sheta, Hussam M / Egstrup, Kenneth / Husic, Mirza / Heinsen, Laurits J / Nieman, Koen / Lambrechtsen, Jess. ·Department of Medical Research, OUH Svendborg Hospital, Institute of Regional Health Research, Valdemarsgade 53, 5700 Svendborg, Denmark. Electronic address: Hussam.sheta@rsyd.dk. · Department of Medical Research, OUH Svendborg Hospital, Institute of Regional Health Research, Valdemarsgade 53, 5700 Svendborg, Denmark. · Erasmus University Medical Centre Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands. · Institute of Regional Health Research, OUH Svendborg Sygehus, Valdemarsgade 53, 5700 Svendborg, Denmark. ·Clin Imaging · Pubmed #27838576.

ABSTRACT: AIMS: To investigate the motion correction algorithm Snapshot-Freeze (SSF) compared to standard reconstruction (STD) in patients randomized to receive beta-blockers (BB) or no beta-blockers (non-BB) before coronary CT, and to investigate if SSF can replace BB. METHODS: One hundred and forty patients scheduled for coronary CT were randomized. All images were reconstructed by the SSF and STD algorithms. Image quality was evaluated according to Likert score (1: excellent, 2: good, 3: adequate, 4: non-diagnostic) and presence of artifacts was noted. RESULTS: Images from 64 patients in the BB group (mean HR 56±4bpm) and 51 patients in the non-BB group (mean HR 67±7bpm) were analyzed. Twenty five patients were excluded because of tachycardia, bradycardia or reconstruction errors in SSF. SSF increased the number of excellent images in both groups compared to the STD algorithm (BB: 59% vs.44%; non-BB: 25% vs. 8%), but the number of non-diagnostic images was not significantly reduced. SSF reduced motion artifacts (BB: 11% vs. 31%; non-BB: 49% vs. 75%), but despite this reduction, motion artifacts in non-BB were still more frequent compared to the BB group analyzed by STD (49% vs. 31%). CONCLUSION: SSF improves image quality and reduces motion artifacts, but does not compensate for the absence of BB.

12 Article Influence of Adaptive Statistical Iterative Reconstruction on coronary plaque analysis in coronary computed tomography angiography. 2016

Precht, Helle / Kitslaar, Pieter H / Broersen, Alexander / Dijkstra, Jouke / Gerke, Oke / Thygesen, Jesper / Egstrup, Kenneth / Lambrechtsen, Jess. ·Department of Medical Research, Odense University Hospital Svendborg, Valdemarsgade 53, Svendborg, Denmark; Conrad Research Center, University College Lillebaelt, Blangstedgaardsvej 4, 5220 Odense SØ, Denmark. Electronic address: hepr@ucl.dk. · Department of Radiology, Division of Image Processing, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands; Medis medical imaging systems bv, Schuttersveld 9, 2300 AJ Leiden, The Netherlands. · Department of Radiology, Division of Image Processing, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands. · Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Odense C, Denmark; Center of Health Economics Research, University of Southern Denmark, Campusvej 55, Odense M, Denmark. · Department of Clinical Engineering, Central Denmark Region, Olof Palmes Allé 15, Århus N, Denmark. · Department of Medical Research, Odense University Hospital Svendborg, Valdemarsgade 53, Svendborg, Denmark. ·J Cardiovasc Comput Tomogr · Pubmed #27769663.

ABSTRACT: PURPOSE: The purpose of this study was to study the effect of iterative reconstruction (IR) software on quantitative plaque measurements in coronary computed tomography angiography (CCTA). METHODS: Thirty patients with a three clinical risk factors for coronary artery disease (CAD) had one CCTA performed. Images were reconstructed using FBP, 30% and 60% adaptive statistical IR (ASIR). Coronary plaque analysis was performed as per patient and per vessel (LM, LAD, CX and RCA) measurements. Lumen and vessel volumes and plaque burden measurements were based on automatic detected contours in each reconstruction. Lumen and plaque intensity measurements and HU based plaque characterization were based on corrected contours copied to each reconstruction. RESULTS: No significant changes between FBP and 30% ASIR were found except for lumen- (-2.53 HU) and plaque intensities (-1.28 HU). Between FBP and 60% ASIR the change in total volume showed an increase of 0.94%, 4.36% and 2.01% for lumen, plaque and vessel, respectively. The change in total plaque burden between FBP and 60% ASIR was 0.76%. Lumen and plaque intensities decreased between FBP and 60% ASIR with -9.90 HU and -1.97 HU, respectively. The total plaque component volume changes were all small with a maximum change of -1.13% of necrotic core between FBP and 60% ASIR. CONCLUSIONS: Quantitative plaque measurements only showed modest differences between FBP and the 60% ASIR level. Differences were increased lumen-, vessel- and plaque volumes, decreased lumen- and plaque intensities and a small percentage change in the individual plaque component volumes.

13 Article Association between high-sensitive troponin I and coronary artery calcification in a Danish general population. 2016

Olson, Fredrik / Engborg, Jonathan / Grønhøj, Mette H / Sand, Niels P / Lambrechtsen, Jess / Steffensen, Flemming H / Nybo, Mads / Gerke, Oke / Mickley, Hans / Diederichsen, Axel C P. ·Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Dk-5000, Odense C, Denmark. Electronic address: fredrik.anders.olsson@rsyd.dk. · Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Dk-5000, Odense C, Denmark. · Department of Cardiology, Sydvestjyst Hospital, Finsensgade 35, DK-6700, Esbjerg, Denmark. · Department of Cardiology, Svendborg Hospital, Valdemarsgade 53, DK-5700, Svendborg, Denmark. · Department of Cardiology, Vejle Hospital, Kabbeltoft 25, DK-7100, Vejle, Denmark. · Department of Clinical Biochemistry, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark. · Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark. · Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Dk-5000, Odense C, Denmark. Electronic address: Axel.Diederichsen@rsyd.dk. ·Atherosclerosis · Pubmed #26714045.

ABSTRACT: BACKGROUND: High-sensitive troponin I (hs-TnI) is an individual predictor of future cardiovascular disease (CVD). However, the relationship between hs-TnI and coronary artery calcification (CAC) as determined by computed tomography (CT) has not previously been investigated in a general population. METHODS: 1173 randomized, middle-aged subjects without known CVD underwent a non-contrast cardiac-CT scan for CAC determination. Hs-TnI was detected using ARCHITECT STAT High Sensitive Troponin-I immunoassay. Total 10-year cardiovascular mortality risk was estimated using HeartScore. The relationship between hs-TnI and CAC was assessed using logistic regression analyses and receiver operating characteristic curves (ROC). RESULTS: Concentrations of hs-TnI above the limit of detection were measured in 89.3% of all subjects. Presence of CAC (Agatston score >0) was detected in 29% in the lowest hs-TnI quartile compared with 55% in the highest, with a stepwise increase over the quartiles. In fully adjusted regression models with dichotomous CAC outcomes, hs-TnI was able to predict presence of CAC (OR: 1.25, 95% CI: 1.03-1.51, p = 0.025) and an Agatston score >100 (OR: 1.36, 95% CI: 1.08-1.71, p = 0.009). Subjects in the fourth hs-TnI quartile had an increased risk for presence of CAC (OR: 1.56, 95% CI: 1.06-2.26, p = 0.024) and for an Agatston score >100 (OR: 1.82, 95% CI: 1.04-3.18, p = 0.035), when compared with the first quartile. Addition of hs-TnI to HeartScore improved the ROCAUC from 0.671 to 0.695 (p < 0.0001). CONCLUSION: Hs-TnI was associated with CAC in a Danish middle-aged population without previously known CVD. This is a step towards understanding hs-TnI as a risk marker for CVD.

14 Article Effects of intensive lipid-lowering therapy on coronary plaques composition in patients with acute myocardial infarction: Assessment with serial coronary CT angiography. 2015

Auscher, Søren / Heinsen, Laurits / Nieman, Koen / Vinther, Kristina Høeg / Løgstrup, Brian / Møller, Jacob Eifer / Broersen, Alexander / Kitslaar, Pieter / Lambrechtsen, Jess / Egstrup, Kenneth. ·Department of Medical Research, OUH/Svendborg Hospital, Denmark. Electronic address: sorenauscher@sol.dk. · Department of Medical Research, OUH/Svendborg Hospital, Denmark. · Department of Cardiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Cardiology, Odense University Hospital, Denmark. · Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands. ·Atherosclerosis · Pubmed #26115069.

ABSTRACT: BACKGROUND: Statins have been shown to possess favourable effects on the cardiovascular system with stabilization of the vulnerable plaque. We sought to assess the effects of early aggressive statin treatment on plaque composition in patients with acute myocardial infarction (AMI), using serial assessment with coronary CT-angiography (CTA). METHODS: In a prospective randomized blinded endpoint trial patients with AMI were randomized to an intensive lipid lowering treatment receiving statin loading with 80 mg rosuvastatin followed by 40 mg daily or standard statin therapy according to current guidelines. Patients were assessed with CTA at baseline and after 12 months with evaluation of plaque volume and composition. RESULTS: In total, 140 patients with AMI were randomized and plaque composition was assessed in 96 patients. In the intensive care group LDL-level was median 1.3 [0.9; 1.5] mmol/l at 12 months follow-up and 2.0 [1.7; 2.4] mmol/l in the usual care group, p < 0.001. Plaque volume increased over 12 months with 43.5 (±225.8) mm(3) in the intensive care group and 19.1 (±190.2) mm(3) in the usual care group, p = 0.57. Plaque composition changed over 12 months with an increase in total dense calcium volume by 11.1 (±39.6) mm(3), corresponding to a 23% increase, in the intensive care group and a decreased by -0.4 (±26.6) mm(3) in the usual care group, p < 0.001. Necrotic core volume increased 26.8 (±122.1) mm(3) in the intensive care group and 25.2 (±80.1) mm(3) in the usual care group, p = 0.94. CONCLUSIONS: Early aggressive lipid lowering therapy significantly increases dense calcium volume in patients with AMI.

15 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.

16 Article Pre-treatment with a sinus node blockade, ivabradine, before coronary CT angiography: a retrospective audit. 2013

Lambrechtsen, J / Egstrup, K. ·Department of cardiology, Odense University Hospital, Svendborg, Denmark. Jess.lambrechtsen@ouh.regionsyddanmark.dk ·Clin Radiol · Pubmed #23809270.

ABSTRACT: AIM: To evaluate whether a simple pre-treatment regimen of sinus node inhibition by ivabradine taken at home for only 1 day resulted in a lower pre-scanning heart rate (HR) and reduced the need for intravenous beta-blockers (BB) prior to coronary computed tomography angiography (CTA). MATERIALS AND METHODS: The pre-treatment regimen for coronary CTA changed from using no medication at home (group 1 patients) to the use of 5 mg ivabradine twice a day (group 2 patients), to using 7.5 mg ivabradine twice a day (group 3 patients). The target HR was the same for groups 1 and 2, but lower for group 3. HRs and the use of intravenous BB before coronary CTA was performed were compared between the study groups. RESULTS: The mean HR immediately before the planned CTA procedure was significantly lower throughout groups 1-3 with values of 70 ± 12.9, 64.9 ± 9.8, and 63.2 ± 10.6 beats/min in groups 1, 2, and 3, respectively (p < 0.001). This resulted in a significantly diminished use of intravenous BB in group 2 (mean 5.1 ± 5.8 mg) compared to group 1 (mean 9 ± 7.6 mg; p = 0.002). The target HR of 65 beats/min was achieved in 37%, 47%, and 61% of groups 1, 2, and 3, respectively (p < 0.0001). CONCLUSION: In conclusion, the administration of ivabradine tablets at home for only 1 day to patients scheduled for coronary CTA resulted in a significantly lower in-clinic HR and a significantly lower mean use of intravenous BB.

17 Article Changes in medical treatment six months after risk stratification with HeartScore and coronary artery calcification scanning of healthy middle-aged subjects. 2012

Sørensen, Mette Hjortdal / Gerke, Oke / Lambrechtsen, Jess / Sand, Niels Peter Rønnow / Mols, Rikke / Thomassen, Anders / Larsen, Mogens Lytken / Mickley, Hans / Diederichsen, Axel C P. ·Department of Cardiology, Odense University Hospital, Odense, Denmark. ·Eur J Prev Cardiol · Pubmed #22019909.

ABSTRACT: OBJECTIVES: The aim was to examine and compare the impact of HeartScore and coronary artery calcification (CAC) score on subsequent changes in the use of medication. METHODS: A total of 1156 healthy men and women, aged 50 or 60, had a baseline medical examination and a coronary artery CT-scan as a part of a screening programme. Using the European HeartScore, the total 10-year cardiovascular mortality risk was estimated (≥5% risk was considered as high). Risk factors and CAC scores were reported to both the patients and their general practitioner. Six months after the screening, follow-up questionnaires addressing current medication were mailed to the participants. RESULTS: A completed questionnaire was returned by 1075 (93%) subjects. At follow up, the overall use of prophylactic medication was significantly increased. Of those with CAC (n = 462) or high HeartScore (n = 233), 21 and 19%, respectively, received lipid-lowering treatment, while 25 and 32%, respectively, received antihypertensive treatment. In multivariate logistic regression analyses, the presence of CAC was associated with an increased use of lipid-lowering treatment (OR 2.2; 95% CI 1.2-4.0), while the presence of a high HeartScore was associated with an increased use of lipid-lowering (OR 2.9; 95% CI 1.6-5.5) and antihypertensive medication (OR 3.4; 95% CI 1.9-6.0). CONCLUSION: Knowledge of present cardiovascular risk factors like high HeartScore and/or CAC leads to beneficial changes in medication. However, at follow up only a minority of high-risk subjects did received prophylactic treatment. CAC score was not superior to HeartScore regarding these motivational outcomes.

18 Article Discrepancy between coronary artery calcium score and HeartScore in middle-aged Danes: the DanRisk study. 2012

Diederichsen, Axel C P / Sand, Niels Peter / Nørgaard, Bjarne / Lambrechtsen, Jess / Jensen, Jesper Møller / Munkholm, Henrik / Aziz, Ahmed / Gerke, Oke / Egstrup, Kenneth / Larsen, Mogens Lytken / Petersen, Henrik / Høilund-Carlsen, Poul F / Mickley, Hans. ·Department of Cardiology, Odense University Hospital, Denmark. axel.diederichsen@ouh.regionsyddanmark.dk ·Eur J Prev Cardiol · Pubmed #21525124.

ABSTRACT: BACKGROUND: Coronary artery calcification (CAC) is an independent and incremental risk marker. This marker has previously not been compared to the HeartScore risk model. DESIGN: A random sample of 1825 citizens (men and women, 50 or 60 years of age) was invited for screening. METHODS: Using the HeartScore model, the 10-year risk of fatal cardiovascular events based on gender, age, smoking, systolic blood pressure, and total cholesterol was estimated. A low risk was defined as <5%. The CAC score was calculated from a non-contrast enhanced cardiac-CT scan and given in Agatston U. RESULTS: A total of 1257 (69%) of the invited subjects were interested in the screening. Due to previous cardiovascular disease or diabetes mellitus, 101 were excluded. Of the remaining 1156, 47% were men and 53% women; one half were 50 years old and the other half 60 years old. A low HeartScore was found in 901 of which 334 (37%) had CAC. A high HeartScore was recorded in 251 of which 80 (32%) did not have any CAC. High HeartScores and CAC were significantly more common in males than females. CONCLUSIONS: CAC is common in healthy middle-aged Danes with a low HeartScore, and, on the contrary, high-risk subjects very frequently do not have CAC. The therapeutic and prognostic implications of these observations remain to be clarified.