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Coronary Artery Disease: HELP
Articles by Lene H. Nielsen
Based on 6 articles published since 2010
(Why 6 articles?)

Between 2010 and 2020, Lene H. Nielsen wrote the following 6 articles about Coronary Artery Disease.
+ Citations + Abstracts
1 Review The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis. 2014

Nielsen, Lene H / Ortner, Nino / Nørgaard, Bjarne L / Achenbach, Stephan / Leipsic, Jonathon / Abdulla, Jawdat. ·Department of Cardiology, Lillebaelt Hospital, Kabbeltoft 25, Vejle 7100, Denmark lenehuche@gmail.com. · Division of Cardiology, Department of Medicine, Glostrup University Hospital, Glostrup, Denmark. · Department of Cardiology B, Aarhus University Hospital Skejby, Aarhus N, Denmark. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · Department of Medical Imaging, St. Paul's Hospital, Vancouver, BC, Canada. ·Eur Heart J Cardiovasc Imaging · Pubmed #24618659.

ABSTRACT: AIMS: To systematically review and perform a meta-analysis of the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single-photon emission computed tomography (SPECT) compared with coronary computed tomography angiography (coronary CTA) in patients suspected of stable coronary artery disease (CAD). METHODS AND RESULTS: We systematically searched for studies published from January 2002 to February 2013 examining the diagnostic accuracy (defined as at least ≥50% luminal obstruction on invasive coronary angiography) and outcomes of coronary CTA (≥16 slice) in comparison with XECG and SPECT. The search revealed 11 eligible studies (N = 1575) comparing the diagnostic accuracy and 7 studies (N = 216.603) the outcomes of coronary CTA vs. XECG or/and SPECT. The per-patient sensitivity [95% confidence interval (95% CI)] to identify significant CAD was 98% (93-99%) for coronary CTA vs. 67% (54-78%) (P < 0.001) for XECG and 99% (96-100%) vs. 73% (59-83%) (P = 0.001) for SPECT. The specificity (95% CI) of coronary CTA was 82% (63-93%) vs. 46% (30-64%) (P < 0.001) for XECG and 71% (60-80%) vs. 48% (31-64%) (P = 0.14) for SPECT. The odds ratio (OR) of downstream test utilization (DTU) for coronary CTA vs. XECG/SPECT was 1.38 (1.33-1.43, P < 0.001), for revascularization 2.63 (2.50-2.77, P < 0.001), for non-fatal myocardial infarction 0.53 (0.39-0.72, P < 0.001), and for all-cause mortality 1.01 (0.87-1.18, P = 0.87). CONCLUSION: The up-front diagnostic performance of coronary CTA is higher than of XECG and SPECT. When compared with XECG/SPECT testing, coronary CTA testing is associated with increased DTU and coronary revascularization.

2 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.

3 Article Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry. 2019

Olesen, Kevin K W / Riis, Anders H / Nielsen, Lene H / Steffensen, Flemming H / Nørgaard, Bjarne L / Jensen, Jesper M / Poulsen, Per L / Thim, Troels / Bøtker, Hans Erik / Sørensen, Henrik T / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark. · Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark. · Departments of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark. ·Eur Heart J Cardiovasc Imaging · Pubmed #31220229.

ABSTRACT: AIMS: We examined whether severity of coronary artery disease (CAD) measured by coronary computed tomography angiography can be used to predict rates of myocardial infarction (MI) and death in patients with and without diabetes. METHODS AND RESULTS: A cohort study of consecutive patients (n = 48 731) registered in the Western Denmark Cardiac Computed Tomography Registry from 2008 to 2016. Patients were stratified by diabetes status and CAD severity (no, non-obstructive, or obstructive). Endpoints were MI and death. Event rates per 1000 person-years, unadjusted and adjusted incidence rate ratios were computed. Median follow-up was 3.6 years. Among non-diabetes patients, MI event rates per 1000 person-years were 1.4 for no CAD, 4.1 for non-obstructive CAD, and 9.1 for obstructive CAD. Among diabetes patients, the corresponding rates were 2.1 for no CAD, 4.8 for non-obstructive CAD, and 12.6 for obstructive CAD. Non-diabetes and diabetes patients without CAD had similar low rates of MI [adjusted incidence rate ratio 1.40, 95% confidence interval (CI): 0.71-2.78]. Among diabetes patients, the adjusted risk of MI increased with severity of CAD (no CAD: reference; non-obstructive CAD: adjusted incidence rate ratio 1.71, 95% CI: 0.79-3.68; obstructive CAD: adjusted incidence rate ratio 4.42, 95% CI: 2.14-9.17). Diabetes patients had higher death rates than non-diabetes patients, irrespective of CAD severity. CONCLUSION: In patients without CAD, diabetes patients have a low risk of MI similar to non-diabetes patients. Further, MI rates increase with CAD severity in both diabetes and non-diabetes patients; with diabetes patients with obstructive CAD having the highest risk of MI.

4 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

5 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.

6 Article Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing. 2011

Nielsen, Lene H / Markenvard, John / Jensen, Jesper M / Mickley, Hans / Øvrehus, Kristian A / Nørgaard, Bjarne L. ·Department of Cardiology, Lillebaelt Hospital-Vejle, Kabbeltoft 25, 7100, Vejle, Denmark. ·Int J Cardiovasc Imaging · Pubmed #21042860.

ABSTRACT: It has been proposed that the increasing use of coronary computed tomographic angiography (CTA) may introduce additional unnecessary diagnostic procedures. However, no previous study has assessed the impact on downstream test utilization of conventional diagnostic testing relative to CTA in patients suspected of angina. The purpose of this study was to investigate the consequences of frontline exercise-stress testing (Ex-test) versus CTA on downstream test utilization in clinical practice. In two collaborating departments using either Ex-test (n = 247) or CTA (n = 251) as the frontline diagnostic test in patients suspected of angina, comparable cohorts of consecutive patients were retrospectively identified (Jan. 2007-Feb. 2008). Downstream test utilization (invasive coronary angiography, ICA; myocardial perfusion scintigraphy, and CTA) during 12 months after the index diagnostic test was recorded. Mean age was 56 years (51% men), and 96% of the total study cohort were at low-intermediate pretest risk of significant coronary disease. Overall, downstream test utilization was more frequent in the Ex-test group than in the CTA group, 32% versus 21% (P = 0.003). Subsequent myocardial scintigraphy was more frequent used (9% versus 4%, P = 0.03), whereas ICA tended to be more frequent applied in the Ex-test versus CTA group (23% vs. 18%, P = 0.15). A frontline diagnostic use in symptomatic patients of Ex-test in comparison to CTA leads to more downstream diagnostic test utilization. Future prospective trials are needed in order to define the most cost-effective diagnostic use of CTA relative to conventional ischemia testing.