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Coronary Artery Disease: HELP
Articles by Henrik Munkholm
Based on 9 articles published since 2010
(Why 9 articles?)
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Between 2010 and 2020, Henrik Munkholm wrote the following 9 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 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.

3 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.

4 Article Patients With Suspected Coronary Artery Disease Referred for Examinations in the Era of Coronary Computed Tomography Angiography. 2015

Zorlak, Ajda / Zorlak, Amet / Thomassen, Anders / Gerke, Oke / Munkholm, Henrik / Mickley, Hans / Diederichsen, Axel C Pyndt. ·Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Vejle Hospital, Vejle, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: axel.diederichsen@rsyd.dk. ·Am J Cardiol · Pubmed #26051377.

ABSTRACT: Invasive coronary angiography (ICA) is the gold standard in the diagnosis of coronary artery disease (CAD), however, associated with rare but severe complications. Patients with a high pretest risk should be referred directly for ICA, whereas a noninvasive strategy is recommended in the remaining patients. In the setting of a university hospital, we investigated the pattern of diagnostic tests used in daily clinical practice. During a 1-year period, consecutive patients with new symptoms suggestive of CAD and referred for exercise stress test, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), or ICA qualified for inclusion. The patients were followed for 1 year, and additional downstream diagnostic tests and need of coronary revascularization were registered. A total of 1,069 patients were included. A noninvasive test was the first examination in 797 patients (75%; exercise stress test in 37, CCTA in 450, and SPECT in 310), whereas 272 (25%) were referred directly to ICA. The ICA group had a significant higher pretest probability for CAD, and the percentage of patients with evidence of significant CAD was 31% (84 of 272 patients), whereas 18% (144 of 797 patients) in the noninvasive group (p <0.0001). In the comparison between CCTA and SPECT, there were no significant differences in downstream testing (16% [72 of 444 patients] vs 17% [53 of 310], p = 0.55), and revascularization rate (20% [14 of 69 patients with positive findings] vs 9% [6 of 67], p = 0.09). In conclusion, a noninvasive diagnostic test was chosen as the first test in 3 of 4 patients. Of the patients referred directly for noninvasive examination, 1/5 had significant CAD, whereas 1/3 of those for invasive examination.

5 Article Lipocalin-type prostaglandin D synthase is not a biomarker of atherosclerotic manifestations. 2014

Hosbond, Susanne E / Diederichsen, Axel C P / Pedersen, Lise / Rasmussen, Lars M / Munkholm, Henrik / Gerke, Oke / Poulsen, Tina S / Mickley, Hans. ·Department of Cardiology, Odense University Hospital , Odense , Denmark. ·Scand J Clin Lab Invest · Pubmed #24456422.

ABSTRACT: OBJECTIVE: Over the last decades Lipocalin-type prostaglandin D synthase (L-PGDS), Osteoprotegerin (OPG), Osteopontin (OPN) and Pregnancy associated plasma protein A (PAPP-A) have been reported to be associated with coronary artery disease, and L-PGDS has been proposed as a potential new diagnostic tool in the setting of stable coronary artery disease. We set out to investigate if measurement of concentrations of these biomarkers could be used to differentiate between four groups of individuals with different atherosclerotic manifestations. METHODS: A total of 120 individuals from four equal gender- and age-matched groups were studied: (i) no previous cardiovascular disease (CVD) and no coronary calcifications [CAC-negative group], (ii) no previous CVD but evidence of severe coronary calcifications [CAC-positive group], (iii) acute coronary syndrome [ACS-group], and (iv) clinical stable patients with CVD, who were referred for cardiovascular surgery [CVD-group]. Concentrations of L-PGDS, OPG, OPN and PAPP-A were analyzed and compared between the four groups. RESULTS: We did not find any significant differences in L-PGDS concentrations between the four groups (p = 0.32). OPG concentrations differed significantly (p = 0.003), with the highest concentration observed in ACS patients. Considering OPN (p = 0.12) and PAPP-A (p = 0.53) their concentrations between groups did not differ significantly. CONCLUSION: The main message from this study is the observation that L-PGDS based on a single blood test appears to be less valuable than previously proposed in identification of patients with coronary artery disease. However, ACS patients have higher OPG concentrations than patients with different manifestations of stable atherosclerosis. Neither OPN nor PAPP-A concentrations differed between groups.

6 Article Risk stratification of patients suspected of coronary artery disease: comparison of five different models. 2012

Jensen, Jesper M / Voss, Mette / Hansen, Vibeke B / Andersen, Lone K / Johansen, Peter B / Munkholm, Henrik / Nørgaard, Bjarne L. ·Department of Cardiology, Lillebælt Hospital Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark. jesper.moeller.jensen@slb.regionsyddanmark.dk ·Atherosclerosis · Pubmed #22189201.

ABSTRACT: OBJECTIVE: To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris. METHODS: Retrospective cohort for creation of CORSCORE by means of logistic regression analysis. Prospective cohort for validation of the five risk models using receiver operating characteristics (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Significant CAD was defined as lumen area diameter reduction ≥50% at coronary angiography. All risk models include information on age, sex, and symptoms. In addition the Duke, Morise, and CORSCORE models include information on tobacco use and hypercholesterolemia. Duke and Morise also include information on diabetes. History of myocardial infarction is used by the Duke and CORSCORE models whereas hypertension is included in the Morise and CORSCORE models. The Duke model includes information on electrocardiogram (ECG) changes and the Morise model includes information on family history, body mass index, obesity, and oestrogen status. RESULTS: 4781 retrospective and 633 prospective consecutive patients referred for coronary angiography were included. The area under the ROC for the updated Diamond-Forrester, Duke, and CORSCORE was significantly larger than for the Diamond-Forrester (p≤0.001). The IDI was significantly higher for the Duke as compared to all other models (p≤0.006). CONCLUSION: The Duke, updated Diamond-Forrester, and CORSCORE risk models are most efficient in predicting CAD in a contemporary cohort of patients with symptoms suggestive of angina. The updated Diamond-Forrester may most operational in daily clinical practice since it is calculated from the lowest number of clinical variables.

7 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.

8 Article Influence of coronary computed tomographic angiography on patient treatment and prognosis in patients with suspected stable angina pectoris. 2011

Ovrehus, Kristian A / Bøtker, Hans E / Jensen, Jesper M / Munkholm, Henrik / Johnsen, Søren P / Nørgaard, Bjarne L. ·Department of Cardiology, Lillebælt Hospital Vejle, Denmark. kristianovrehus@hotmail.com ·Am J Cardiol · Pubmed #21420047.

ABSTRACT: We evaluated the influence of coronary computed tomographic angiography (CTA) as a first-line diagnostic test on patient treatment and prognosis. A total of 1,055 consecutive patients with suspected stable angina pectoris (mean age 55 ± 10 years, 56% women) and a low to intermediate pretest likelihood of coronary artery disease (CAD) were included in the present study. The patients were followed for a median of 18 months. The use of downstream diagnostic testing and medical therapy after CTA were recorded. The CTA result was normal in 49%, and nonobstructive and obstructive CAD (≥50% stenosis) was demonstrated in 31% and 15% of the patients, respectively. Coronary CTA was inconclusive in 5% of the patients. The use of antiplatelet therapy decreased with normal findings from CTA, and the use of antiplatelet and lipid-lowering agents increased in patients with CAD. Additional testing was performed in 2% of patients with normal CTA findings and in 7% and 82% of patients with nonobstructive or obstructive CAD, respectively. No patients without CAD, 0.9% of patients with nonobstructive CAD, and 1.9% of patients with obstructive CAD met the primary end point (cardiovascular death and myocardial infarction, p = 0.008). No patients without CAD, 1.5% of patients with nonobstructive CAD, and 30% patients with obstructive CAD met the secondary end point (cardiovascular death, myocardial infarction, and coronary revascularization, p <0.0001). In conclusion, in patients suspected of having angina, the findings from CTA influence patient treatment without resulting in excessive additional testing. Coronary CTA provides important prognostic information, with excellent intermediate-term outcomes in patients with normal CTA findings.

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

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

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