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Coronary Artery Disease: HELP
Articles by Eva Prescott
Based on 37 articles published since 2010
(Why 37 articles?)
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Between 2010 and 2020, Eva Prescott wrote the following 37 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013

Anonymous21063 / Montalescot, Gilles / Sechtem, Udo / Achenbach, Stephan / Andreotti, Felicita / Arden, Chris / Budaj, Andrzej / Bugiardini, Raffaele / Crea, Filippo / Cuisset, Thomas / Di Mario, Carlo / Ferreira, J Rafael / Gersh, Bernard J / Gitt, Anselm K / Hulot, Jean-Sebastien / Marx, Nikolaus / Opie, Lionel H / Pfisterer, Matthias / Prescott, Eva / Ruschitzka, Frank / Sabaté, Manel / Senior, Roxy / Taggart, David Paul / van der Wall, Ernst E / Vrints, Christiaan J M / Anonymous31063 / Zamorano, Jose Luis / Achenbach, Stephan / Baumgartner, Helmut / Bax, Jeroen J / Bueno, Héctor / Dean, Veronica / Deaton, Christi / Erol, Cetin / Fagard, Robert / Ferrari, Roberto / Hasdai, David / Hoes, Arno W / Kirchhof, Paulus / Knuuti, Juhani / Kolh, Philippe / Lancellotti, Patrizio / Linhart, Ales / Nihoyannopoulos, Petros / Piepoli, Massimo F / Ponikowski, Piotr / Sirnes, Per Anton / Tamargo, Juan Luis / Tendera, Michal / Torbicki, Adam / Wijns, William / Windecker, Stephan / Anonymous41063 / Knuuti, Juhani / Valgimigli, Marco / Bueno, Héctor / Claeys, Marc J / Donner-Banzhoff, Norbert / Erol, Cetin / Frank, Herbert / Funck-Brentano, Christian / Gaemperli, Oliver / Gonzalez-Juanatey, José R / Hamilos, Michalis / Hasdai, David / Husted, Steen / James, Stefan K / Kervinen, Kari / Kolh, Philippe / Kristensen, Steen Dalby / Lancellotti, Patrizio / Maggioni, Aldo Pietro / Piepoli, Massimo F / Pries, Axel R / Romeo, Francesco / Rydén, Lars / Simoons, Maarten L / Sirnes, Per Anton / Steg, Ph Gabriel / Timmis, Adam / Wijns, William / Windecker, Stephan / Yildirir, Aylin / Zamorano, Jose Luis. ·The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines. ·Eur Heart J · Pubmed #23996286.

ABSTRACT: -- No abstract --

2 Review The prognostic value of coronary endothelial and microvascular dysfunction in subjects with normal or non-obstructive coronary artery disease: A systematic review and meta-analysis. 2018

Brainin, Philip / Frestad, Daria / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. · Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark. · Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. Electronic address: epre0004@regionh.dk. ·Int J Cardiol · Pubmed #29407076.

ABSTRACT: AIMS: Coronary vascular dysfunction is linked with poor cardiovascular prognosis in patients without obstructive coronary artery disease (CAD) but a critical appraisal of the literature is lacking. METHODS AND RESULTS: We performed a systematic review and meta-analysis to quantify the cardiovascular risk associated with endothelial dependent and non-endothelial dependent coronary vascular dysfunction in patients with normal or non-obstructive CAD (epicardial stenosis <50%). Prospective cohort studies that reported coronary vascular dysfunction at baseline and cardiovascular outcomes at follow-up were included. We identified 52 papers of which 26 were included in the meta-analyses. Study populations included stable angina (n=15), heart failure (n=4), diabetes (n=2), hypertrophic obstructive cardiomyopathy (n=2), chronic kidney disease, aortic stenosis and left atrial enlargement (each n=1): RR estimates were similar in patients with stable angina and other patient groups. For epicardial endothelial dependent dysfunction (six studies, 243 events in 1192 patients) the summarized RR was 2.38 (95% confidence intervals (95% CI) 1.74-3.25), for non-endothelial dependent dysfunction assessed as coronary flow velocity reserve (CFVR) by echocardiography (10 studies, 428 events in 5134 patients) RR was 4.58 (95% CI 3.58-5.87) and for coronary flow reserve (CFR) by PET (10 studies, 538 events in 3687 patients) RR was 2.44 (95% CI 1.80-3.30). However, RR estimates were robust in a series of sensitivity analyses. CONCLUSION: The presence of coronary vascular dysfunction in patients with normal or non-obstructive CAD predicts adverse cardiovascular outcome. Multicentre studies and uniform guidelines for assessing coronary vascular dysfunction are encouraged.

3 Review Women with Stable Angina Pectoris and No Obstructive Coronary Artery Disease: Closer to a Diagnosis. 2017

Michelsen, Marie Mide / Mygind, Naja Dam / Frestad, Daria / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen Copenhagen, Denmark. ·Eur Cardiol · Pubmed #30416544.

ABSTRACT: A large proportion of women with chest pain have no obstructive coronary artery disease. Recent studies have demonstrated that these women continue to have symptoms and are at increased risk of cardiovascular morbidity and mortality. Coronary microvascular dysfunction (CMD) leads to an impairment of blood flow regulation to the myocardium and possible transient ischaemia. CMD is a disease entity with several pathophysiologic aspects and diagnostic modalities continue to be developed. However, due to the complexity of the disease, it remains elusive whether CMD is the explanation for the symptoms and the poor prognosis in women with angina and no obstructive coronary artery disease.

4 Review Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris. 2015

Ong, Peter / Aziz, Ahmed / Hansen, Henrik Steen / Prescott, Eva / Athanasiadis, Anastasios / Sechtem, Udo. ·Department of Cardiology, Robert Bosch Krankenhaus. ·Circ J · Pubmed #26084380.

ABSTRACT: Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical coherence tomography have been applied to study the coronary pathology in patients with vasospastic angina. Patients with vasospastic angina represent a heterogeneous cohort of patients with regard to the extent of concomitant coronary atherosclerosis. They share the common pathophysiological phenomenon of vascular smooth muscle hyperreactivity leading to spasm caused by various factors that may also overlap. Focal coronary spasm is related to epicardial atherosclerosis and in the presence of obstructive coronary artery disease it may be useful to treat the lesion to prevent further spasm. The aim of this article is to review structural and functional coronary artery abnormalities in patients with vasospastic angina.

5 Article 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. 2020

Knuuti, Juhani / Wijns, William / Saraste, Antti / Capodanno, Davide / Barbato, Emanuele / Funck-Brentano, Christian / Prescott, Eva / Storey, Robert F / Deaton, Christi / Cuisset, Thomas / Agewall, Stefan / Dickstein, Kenneth / Edvardsen, Thor / Escaned, Javier / Gersh, Bernard J / Svitil, Pavel / Gilard, Martine / Hasdai, David / Hatala, Robert / Mahfoud, Felix / Masip, Josep / Muneretto, Claudio / Valgimigli, Marco / Achenbach, Stephan / Bax, Jeroen J / Anonymous991054. · ·Eur Heart J · Pubmed #31504439.

ABSTRACT: -- No abstract --

6 Article Imaging in ESC clinical guidelines: chronic coronary syndromes. 2019

Saraste, Antti / Barbato, Emanuele / Capodanno, Davide / Edvardsen, Thor / Prescott, Eva / Achenbach, Stephan / Bax, Jeroen J / Wijns, William / Knuuti, Juhani. ·Turku PET Centre, Turku University Hospital, University of Turku, Kiinamllynkatu 4-8, Turku, Finland. · Heart Center, Turku University Hospital, Hämeentie 11, Turku, Finland. · Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Via S. Pansini, 5, Naples, Italy. · CardioThoracic-Vascular and Transplant Department, A.O.U. 'Policlinico-Vittorio Emanuele', University of Catania, Via Citelli 6, Catania, Italy. · Department of Cardiology, Oslo University Hospital, University of Oslo, Oslo, Norway. · Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. · Department of Cardiology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands. · The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, University Road, Galway, Ireland. ·Eur Heart J Cardiovasc Imaging · Pubmed #31642920.

ABSTRACT: The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). The 2019 guideline identified six common clinical scenarios of CCS defined by the different evolutionary phases of coronary artery disease (CAD), excluding the situations in which an acute coronary event, often with coronary thrombus formation, dominates the clinical presentation. This review aims at providing a summary of novel or revised concepts in the guidelines together with the recent data underlying the major changes on the use of cardiac imaging in patients with suspected or known CCS. Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of CAD based on age, sex and symptoms have been adjusted substantially downward as compared with 2013 ESC guidelines. Further, the impact of various risk factors and modifiers on the pre-test probability was highlighted and a new concept of 'Clinical likelihood of CAD' was introduced. Recommendations regarding diagnostic tests to establish or rule-out obstructive CAD have been updated with recent data on their diagnostic performance in different patient groups and impact on patient outcome. As the initial strategy to diagnose CAD in symptomatic patients, non-invasive functional imaging for myocardial ischaemia, coronary computed tomography angiography or invasive coronary angiography combined with functional evaluation may be used, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests instead of the exercise electrocardiogram are recommended when following the non-invasive diagnostic strategy.

7 Article Effects of 1 year of exercise training versus combined exercise training and weight loss on body composition, low-grade inflammation and lipids in overweight patients with coronary artery disease: a randomized trial. 2019

Pedersen, Lene Rørholm / Olsen, Rasmus Huan / Anholm, Christian / Astrup, Arne / Eugen-Olsen, Jesper / Fenger, Mogens / Simonsen, Lene / Walzem, Rosemary L / Haugaard, Steen Bendix / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Building 67, 1st, Bispebjerg Bakke 23, 2400, Copenhagen, NW, Denmark. lrpedersen@gmail.com. · Department of Cardiology, University Hospital of Zealand, Roskilde, University of Copenhagen, Copenhagen, Denmark. lrpedersen@gmail.com. · Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Building 67, 1st, Bispebjerg Bakke 23, 2400, Copenhagen, NW, Denmark. · Department of Internal Medicine, Glostrup University Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark. · Clinical Research Centre, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Medical Biochemistry, Genetics and Molecular Biochemistry, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Clinical Physiology and Nuclear Medicine, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark. · Faculty of Nutrition, Texas A & M University, College Station, TX, USA. · Department of Internal Medicine, Amager and Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark. ·Cardiovasc Diabetol · Pubmed #31575375.

ABSTRACT: BACKGROUND: Dyslipidaemia and low-grade inflammation are central in atherogenesis and linked to overweight and physical inactivity. Lifestyle changes are important in secondary prevention of coronary artery disease (CAD). We compared the effects of combined weight loss and interval training with interval training alone on physical fitness, body composition, dyslipidaemia and low-grade inflammation in overweight, sedentary participants with CAD. METHODS: Seventy CAD patients, BMI 28-40 kg/m RESULTS: Twenty-six (74%) AIT and 29 (83%) LED + AIT participants completed the study. At baseline subject included 43 (78%) men; subjects averages were: age 63 years (6.2), body weight 95.9 kg (12.2) and VO CONCLUSIONS: Both interventions were feasible. Both groups obtained improvements in VO

8 Article Drug-eluting stents in large coronary vessels improve both safety and efficacy compared with bare-metal stents in women: a pooled analysis of the BASKET-PROVE I and II trials. 2019

Bjerking, Louise Hougesen / Hansen, Kim Wadt / Sørensen, Rikke / Prescott, Eva / Biering-Sørensen, Tor / Jeger, Raban / Kaiser, Christoph / Pfisterer, Matthias / Galatius, Søren. ·Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. · Department of Cardiology, Herlev Gentofte University Hospital, Hellerup, Denmark. · Department of Cardiology, University Hospital Basel, Basel, Switzerland. ·Open Heart · Pubmed #31217999.

ABSTRACT: Background: Drug-eluting stents (DES) have proven superior to bare-metal stents (BMS) in terms of safety and efficacy. However, inference to the female subgroup has been limited by low enrolment rates of women in clinical trials. The objective of this study was to investigate the safety and efficacy of DES versus BMS in women and men. Methods: In a pooled analysis of two all-comers randomised trials (Basel Stent Kosten-Effektivitäts Trial-Prospective Validation Examination (BASKET-PROVE) and BASKET-PROVE II) (n=4605), we examined safety and efficacy of DES versus BMS according to sex. Patients were followed 2 years for a composite endpoint of cardiac death, non-fatal myocardial infarction (MI) and clinically driven target-vessel revascularisation not related to MI. Results: Among the 1076 women and 3529 men included in the analysis, 65.6% of the women and 67.2% of the men were randomised to receive DES. At baseline, men had more complex coronary artery disease than women. After 2 years, DES reduced rates of major adverse cardiac events (MACE) compared with BMS in both women (cumulative incidence, 6.1% vs 14.7%; adjusted HR 0.36 (95% CI 0.24 to 0.54)) and men (7.7 vs 12.1%, HR 0.62 (0.50 to 0.77)), although the reduction in MACE rates was more pronounced in women (adjusted p=0.02 for sex-stent interaction). Event rates were lower in DES for both safety and efficacy outcomes, with the largest effect seen for non-MI TVR, in both women (2.3 vs 9.2%, adjusted HR 0.24 (0.13 to 0.44)) and men (4.0 vs 7.8%, adjusted HR 0.48 (0.36 to 0.64)) (adjusted p=0.049 for sex-stent interaction). Conclusions: In patients requiring stenting of large coronary arteries, DES were associated with improved safety in women and superior efficacy in both sexes as compared with BMS.

9 Article Overlap between angina without obstructive coronary artery disease and left ventricular diastolic dysfunction with preserved ejection fraction. 2019

Michelsen, Marie Mide / Pena, Adam / Mygind, Naja D / Høst, Nis / Gustafsson, Ida / Hansen, Peter Riis / Hansen, Henrik Steen / Kastrup, Jens / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. ·PLoS One · Pubmed #31120897.

ABSTRACT: BACKGROUND: A link between angina with no obstructive coronary artery disease (CAD) and heart failure with preserved left ventricular ejection fraction has been proposed, but evidence in support of this is lacking. In a cross-sectional study, we investigated whether left ventricular diastolic function in women with angina pectoris and no obstructive CAD differed from a reference population. METHODS: We included 956 women with angina and <50% coronary artery stenosis at invasive coronary angiography. Women with cardiovascular risk factors, but no history of chest pain or cardiac disease served as controls (n = 214). Left ventricular diastolic function was assessed by transthoracic echocardiography. RESULTS: The women with angina were slightly older, had higher body mass index, higher heart rate, and more had diabetes compared with controls while systolic blood pressure was lower. In age-adjusted analyses, angina patients had significantly lower E/A (Estimated difference -0.13, 95% CI: -0.17; -0.08), higher left ventricular mass index (5.73 g/m2, 95% CI: 3.71; 7.75), left atrial volume index (2.34 ml/m2, 95% CI: 1.23; 3.45) and E/e' (0.68, 95% CI: 0.30; 1.05) and a larger proportion had higher estimated left ventricular filling pressure (17% versus 6%, p = 0.001). No between group differences were seen for e' or deceleration time. After adjustment for known cardiovascular risk factors, between group differences for echocardiographic parameters remained statistically significant. CONCLUSIONS: Patients with angina and no obstructive CAD had a more impaired left ventricular diastolic function compared with an asymptomatic reference population. This suggests some common pathophysiological pathway between the two syndromes.

10 Article Coronary microvascular dysfunction is associated with cardiac time intervals in women with angina and no obstructive coronary artery disease: An iPOWER substudy. 2019

Pena, Adam / Michelsen, Marie Mide / Mygind, Naja Dam / Gustafsson, Ida / Høst, Nis / Bech, Jan / Kastrup, Jens / Hansen, Henrik Steen / Hansen, Peter Riis / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. · Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark. · Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. ·Echocardiography · Pubmed #31012159.

ABSTRACT: BACKGROUND: Coronary microvascular dysfunction (CMD) may cause angina in the absence of obstructive coronary artery disease (CAD) and increases the risk of future adverse cardiovascular events. Transthoracic Doppler echocardiography (TTDE) with pharmacological stress can assess coronary flow velocity reserve (CFVR), a measure of coronary microvascular function. However, simpler methods would be preferable for diagnosing CMD. Therefore, we examined the relationship between CFVR and cardiac time intervals measured by TTDE in a cohort of women with angina and no obstructive CAD. METHODS: In a prospective cohort study, we included 389 women with angina, left ventricular ejection fraction > 45%, and no obstructive CAD. CMD was defined as CFVR < 2.0. The study population was divided into three groups according to cutoff values of CFVR < 2, 2 ≤ CFVR ≤ 2.5, and CFVR > 2.5. Isovolumic contraction time (IVCT), ejection time (ET), and isovolumic relaxation time (IVRT) were measured by tissue Doppler M-mode, and the myocardial performance index (MPI = (IVCT + IVRT)/ET) was calculated. RESULTS: Coronary microvascular dysfunction was associated with increasing age, hypertension, higher resting heart rate, and lower diastolic blood pressure. Moreover, CMD was associated with higher E/e' ratio (P = 0.002) and longer IVCT (P < 0.001), higher MPI (P < 0.001) and shorter ET (P = 0.002), but not with IVRT or conventional measures of left ventricular geometry, mass, and function. In multivariable analysis, longer IVCT (P < 0.001) and higher MPI (P = 0.002) remained associated with CMD. CONCLUSION: In women with angina and no obstructive CAD, CMD is associated with longer IVCT and higher MPI indicating a link between CMD and subtle alternations of systolic and combined measures of cardiac time intervals.

11 Article Impact of a decreasing pre-test probability on the performance of diagnostic tests for coronary artery disease. 2019

Juarez-Orozco, Luis Eduardo / Saraste, Antti / Capodanno, Davide / Prescott, Eva / Ballo, Haitham / Bax, Jeroen J / Wijns, William / Knuuti, Juhani. ·Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland. · Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Via Citelli 6, Catania, Italy. · Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands. · The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, National University of Ireland Galway, University College Hospital Galway, Newcastle Rd, Galway, Ireland. ·Eur Heart J Cardiovasc Imaging · Pubmed #30982851.

ABSTRACT: AIMS: To provide a pooled estimation of contemporary pre-test probabilities (PTPs) of significant coronary artery disease (CAD) across clinical patient categories, re-evaluate the utility of the application of diagnostic techniques according to such estimates, and propose a comprehensive diagnostic technique selection tool for suspected CAD. METHODS AND RESULTS: Estimates of significant CAD prevalence across sex, age, and type of chest pain categories from three large-scale studies were pooled (n = 15 815). The updated PTPs and diagnostic performance profiles of exercise electrocardiogram, invasive coronary angiography, coronary computed tomography angiography (CCTA), positron emission tomography (PET), stress cardiac magnetic resonance (CMR), and SPECT were integrated to define the PTP ranges in which ruling-out CAD is possible with a post-test probability of <10% and <5%. These ranges were then integrated in a new colour-coded tabular diagnostic technique selection tool. The Bayesian relationship between PTP and the rate of diagnostic false positives was explored to complement the characterization of their utility. Pooled CAD prevalence was 14.9% (range = 1-52), clearly lower than that used in current clinical guidelines. Ruling-out capabilities of non-invasive imaging were good overall. The greatest ruling-out capacity (i.e. post-test probability <5%) was documented by CCTA, PET, and stress CMR. With decreasing PTP, the fraction of false positive findings rapidly increased, although a lower CAD prevalence partially cancels out such effect. CONCLUSION: The contemporary PTP of significant CAD across symptomatic patient categories is substantially lower than currently assumed. With a low prevalence of the disease, non-invasive testing can rarely rule-in the disease and focus should shift to ruling-out obstructive CAD. The large proportion of false positive findings must be taken into account when patients with low PTP are investigated.

12 Article Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease. 2019

Mygind, Naja Dam / Pena, Adam / Mide Michelsen, Marie / Ali Qayyum, Abbas / Frestad, Daria / Emil Christensen, Thomas / Ali Ghotbi, Adam / Hasbak, Phillip / Kjaer, Andreas / Vejlstrup, Niels / Gustafsson, Ida / Riis Hansen, Peter / Steen Hansen, Henrik / Prescott, Eva / Kastrup, Jens. ·a Department of Cardiology, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark. · b Department of Cardiology , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark. · c Department of Cardiology , Herlev-Gentofte Hospital, University of Copenhagen , Hellerup , Denmark. · d Department of Cardiology , Hvidovre Hospital, University of Copenhagen , Hvidovre, Denmark. · e Department of Clinical Physiology Nuclear Medicine & PET and Cluster for Molecular Imaging , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark. · f Department of Cardiology , Odense University Hospital University of Southern Denmark , Odense, Denmark. ·Scand J Clin Lab Invest · Pubmed #30889989.

ABSTRACT: Coronary microvascular dysfunction (CMD) is associated with a poor prognosis even in absence of obstructive coronary artery disease. CMD can be assessed as a myocardial blood flow reserve by positron emission tomography (PETMBFR) and as coronary flow velocity reserve by transthoracic Doppler echocardiography (TTDECFVR). Impaired first-pass perfusion assessed by cardiac magnetic resonance (CMR) is an early sign of ischemia. We aimed to investigate the association between CMD and CMR first-pass perfusion. Women (n = 66) with angina pectoris and an invasive coronary angiogram (<50% stenosis) were assessed by TTDECFVR and in a subgroup of these (n = 54) also by PETMBFR. Semi-quantitative evaluation of first-pass perfusion at rest and adenosine stress was assessed by gadolinium CMR in all 66 women. Four measures of CMR perfusion reserve were calculated using contrast upslope, maximal signal intensity and both indexed to arterial input. Mean (standard deviation) age was 62 (8) years. Median (interquartile range) TTDECFVR was 2.3 (1.8;2.7) and PETMBFR was 2.7 (2.2;3.1). Using a cut-off of 2.0 for TTDECFVR and 2.5 for PETMBFR, 25 (38%) and 21 (39%) had CMD, respectively. CMR myocardial perfusion reserve from contrast upslope (CMR_MPRupslope) showed moderate but significant correlation with PETMBFR (R = .46, p < .001) while none of the other CMR variables were associated with CMD. A CMR_MPRupslope cut-off of 0.78 identified CMD, area under the curve 0.73 (p = .001). The results indicate that CMR_MPRupslope may be associated to PETMBFR; a measure of CMD. Further research is needed to validate and implement the use of CMR first pass perfusion in this population.

13 Article Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. 2019

Reeh, Jacob / Therming, Christina Bachmann / Heitmann, Merete / Højberg, Søren / Sørum, Charlotte / Bech, Jan / Husum, Dorte / Dominguez, Helena / Sehestedt, Thomas / Hermann, Thomas / Hansen, Kim Wadt / Simonsen, Lene / Galatius, Søren / Prescott, Eva. ·Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark. · Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Frederiksberg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark. ·Eur Heart J · Pubmed #30561616.

ABSTRACT: AIMS: We hypothesized that the modified Diamond-Forrester (D-F) prediction model overestimates probability of coronary artery disease (CAD). The aim of this study was to update the prediction model based on pre-test information and assess the model's performance in predicting prognosis in an unselected, contemporary population suspected of angina. METHODS AND RESULTS: We included 3903 consecutive patients free of CAD and heart failure and suspected of angina, who were referred to a single centre for assessment in 2012-15. Obstructive CAD was defined from invasive angiography as lesion requiring revascularization, >70% stenosis or fractional flow reserve <0.8. Patients were followed (mean follow-up 33 months) for myocardial infarction, unstable angina, heart failure, stroke, and death. The updated D-F prediction model overestimated probability considerably: mean pre-test probability was 31.4%, while only 274 (7%) were diagnosed with obstructive CAD. A basic prediction model with age, gender, and symptoms demonstrated good discrimination with C-statistics of 0.86 (95% CI 0.84-0.88), while a clinical prediction model adding diabetes, family history, and dyslipidaemia slightly improved the C-statistic to 0.88 (0.86-0.90) (P for difference between models <0.0001). Quartiles of probability of CAD from the clinical prediction model provided good diagnostic and prognostic stratification: in the lowest quartiles there were no cases of obstructive CAD and cumulative risk of the composite endpoint was less than 3% at 2 years. CONCLUSION: The pre-test probability model recommended in current ESC guidelines substantially overestimates likelihood of CAD when applied to a contemporary, unselected, all-comer population. We provide an updated prediction model that identifies subgroups with low likelihood of obstructive CAD and good prognosis in which non-invasive testing may safely be deferred.

14 Article Accelerated collagen turnover in women with angina pectoris without obstructive coronary artery disease: An iPOWER substudy. 2018

Nielsen, Signe H / Mygind, Naja D / Michelsen, Marie M / Bechsgaard, Daria F / Suhrs, Hannah E / Genovese, Federica / Nielsen, Henning B / Brix, Susanne / Karsdal, Morten / Prescott, Eva / Kastrup, Jens. ·1 Fibrosis Biology and Biomarkers, Nordic Bioscience, Denmark. · 2 Department of Biotechnology and Biomedicine, Technical University of Denmark, Denmark. · 3 Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. · 4 Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. · 5 Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark. · 6 ProScion, Herlev, Denmark. ·Eur J Prev Cardiol · Pubmed #29436257.

ABSTRACT: Aim Collagens are major cardiac extracellular matrix components, known to be actively remodelled and accumulated during diffuse myocardial fibrosis. We evaluated whether accelerated collagen turnover described by neo-epitope biomarkers reflecting collagen formation and degradation separates patients with diffuse myocardial fibrosis from asymptomatic controls. Methods and results Seventy-one women with angina pectoris without significant coronary artery disease assessed by invasive coronary angiogram were included. Competitive enzyme-linked immunosorbent assays (ELISAs) measuring circulating protein fragments in serum assessed the formation and degradation of collagen type III (Pro-C3, C3M and C3C), IV (P4NP7S and C4M), V (Pro-C5 and C5M) and VI (Pro-C6 and C6M), and degradation of collagen type I (C1M). Serum samples from 32 age-matched asymptomatic women were included as controls. Symptomatic women presented significantly elevated levels of Pro-C6, C3C, C3M, C4M and C8-C ( p < 0.0001-0.0058) and significantly decreased levels of Pro-C3, C5M and C6M ( p < 0.0001-0.041), reflecting accelerated collagen turnover and an imbalanced collagen formation and degradation compared to controls. Cardiac magnetic resonance T1 mapping was performed to determine extracellular volume fraction and thus diffuse myocardial fibrosis. A significant association was identified between C5M and extracellular volume fraction by cardiac magnetic resonance ( p = 0.01). Conclusion Women with angina pectoris, but without significant obstructive coronary artery disease, showed an imbalanced collagen turnover compared to asymptomatic controls. The examined biomarkers are tools to monitor active collagen remodelling in patients with angina pectoris, in risk of developing myocardial fibrosis.

15 Article Low diagnostic yield of non-invasive testing in patients with suspected coronary artery disease: results from a large unselected hospital-based sample. 2018

Therming, Christina / Galatius, Søren / Heitmann, Merete / Højberg, Søren / Sørum, Charlotte / Bech, Jan / Husum, Dorte / Dominguez, Helena / Sehestedt, Thomas / Hermann, Thomas / Reeh, Jacob / Simonsen, Lene / Prescott, Eva. ·Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. · Department of Clinical Physiology and Nuclear Medicine, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. ·Eur Heart J Qual Care Clin Outcomes · Pubmed #29267950.

ABSTRACT: Aims: Stable angina is the most common presentation of heart disease and has a good prognosis. With declining coronary artery disease (CAD), rates a diagnostic approach balancing costs and benefits is a challenge, particularly in women. This study describes the real-life diagnostic workup in a large hospital to explore whether the diagnostic approach may be improved. Methods and results: We identified 4028 patients free of CAD, referred for and assessed with non-invasive (NIT) or invasive test for stable suspected CAD in 2012-15. In both the sexes, the majority (>85%) presented with chest pain as primary symptom. Women had more non-angina (60.2 vs. 54.5%) and less typical angina (8.2 vs. 11.8%, P < 0.001). Despite a mean pretest probability of 20.9% in women and 45.1% in men (P < 0.001), only 69 (3.1%) women and 190 men (10.4%) were diagnosed with obstructive CAD. In all, 93% underwent a NIT and 80% of these were normal. Among the 1238 men and 1595 women with non-angina or dyspnoea, only 6.1% and 2.9%, respectively, had positive NIT. After multiple adjustments, women remained less likely to have positive NIT [odds ratio (OR) 0.42 95% confidence interval (95% CI 0.32-0.56)] and given a positive test also less likely to have obstructive CAD [OR 0.30 (0.17-0.52)]. The C-statistics for predicting positive NIT was 0.77 (0.72-0.82) in women and 0.77 (0.74-0.80) in men. Conclusion: These data confirm the very low diagnostic yield of non-invasive and invasive assessment of CAD in current clinical practice, particularly in women and in patients with atypical symptoms. Data call for a more rational approach to avoid unnecessary testing.

16 Article Coronary microvascular dysfunction and myocardial contractile reserve in women with angina and no obstructive coronary artery disease. 2018

Michelsen, Marie M / Pena, Adam / Mygind, Naja D / Bech, Jan / Gustafsson, Ida / Kastrup, Jens / Hansen, Henrik S / Høst, Nis / Hansen, Peter R / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. ·Echocardiography · Pubmed #29222822.

ABSTRACT: BACKGROUND: Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. We investigated whether CMD was associated with left ventricular diastolic and systolic function at rest and during pharmacologically induced hyperemic stress. METHODS: In a prospective cohort study, we included 963 women with angina, left ventricular ejection fraction (LVEF) >45%, and an invasive coronary angiogram without significant stenosis (<50%). Parameters of left ventricular diastolic function, LVEF, speckle tracking-derived global longitudinal strain (GLS), and coronary flow velocity reserve (CFVR) were assessed by transthoracic echocardiography at rest and during dipyridamole stress. The GLS and LVEF reserves were defined as the absolute increases in GLS and LVEF during stress. RESULTS: Coronary flow velocity reserve (CFVR) was measured in 919 women of whom 26% had CMD (defined as CFVR < 2). Coronary microvascular dysfunction (CMD) was associated with higher age and a higher resting heart rate. Women with CMD had a reduced GLS reserve (P = .005), while we found no association between CFVR and LVEF at rest, GLS at rest, or the LVEF reserve, respectively. Global longitudinal strain (GLS) reserve remained associated with CFVR (P = .002) in a multivariable regression analysis adjusted for age, hemodynamic variables, and GLS at rest. In age-adjusted analysis, women with low CFVR had no signs of left ventricular diastolic dysfunction measured by echocardiography at rest. CONCLUSION: The GLS reserve was significantly lower in women with CMD. The mechanisms underlying the association between CMD and GLS reserve warrant further study.

17 Article Ventricular repolarization alterations in women with angina pectoris and suspected coronary microvascular dysfunction. 2018

Dose, Nynne / Michelsen, Marie Mide / Mygind, Naja Dam / Pena, Adam / Ellervik, Christina / Hansen, Peter R / Kanters, Jørgen K / Prescott, Eva / Anonymous3030920 / Kastrup, Jens / Gustafsson, Ida / Hansen, Henrik Steen. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. Electronic address: nynned@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. · Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Denmark. · Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Production, Research and Innovation, Region Zealand, Sorø, Denmark. · Department of Biomedical Science, University of Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, University of Southern Denmark, Denmark. ·J Electrocardiol · Pubmed #28939174.

ABSTRACT: OBJECTIVES: CMD could be the explanation of angina pectoris with no obstructive CAD and may cause ventricular repolarization changes. We compared T-wave morphology and QTc interval in women with angina pectoris with a control group as well as the associations with CMD. METHODS: Women with angina pectoris and no obstructive coronary artery disease (n=138) and age-matched controls were compared in regard to QTc interval and morphology combination score (MCS) based on T-wave asymmetry, flatness and presence of T-wave notch. CMD was assessed as a coronary flow velocity reserve (CFVR) by transthoracic echocardiography. RESULTS: Women with angina pectoris had significantly longer QTc intervals (429±20ms) and increased MCS (IQR) (0.73 [0.64-0.80]) compared with the controls (419±20ms) and (0.63 [(0.53-0.73]), respectively (both p<0.001). CFVR was associated with longer QTc interval (p=0.02), but the association was attenuated after multivariable adjustment (p=0.08). CONCLUSION: This study suggests that women with angina pectoris have alterations in T-wave morphology as well as longer QTc interval compared with a reference population. CMD might be an explanation.

18 Article Sex-Related Differences in Vasomotor Function in Patients With Angina and Unobstructed Coronary Arteries. 2017

Aziz, Ahmed / Hansen, Henrik Steen / Sechtem, Udo / Prescott, Eva / Ong, Peter. ·Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany; Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: Ahmed.Aziz@rsyd.dk. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. ·J Am Coll Cardiol · Pubmed #29096805.

ABSTRACT: BACKGROUND: Coronary vasomotor dysfunction is an important mechanism for angina in patients with unobstructed coronary arteries. OBJECTIVES: The purpose of this study was to determine sex differences in the prevalence and clinical presentation of vasomotor dysfunction in a European population and to examine sex differences in the dose of acetylcholine leading to a positive acetylcholine provocation test (ACH test). METHODS: Between 2007 and 2014, we included 1,379 consecutive patients with stable angina, unobstructed coronaries and ACH test performed for epicardial vasospasm or coronary microvascular dysfunction (CMD) due to microvascular spasm. The predictive value of sex, risk factors, symptoms, and noninvasive test results was analyzed by means of logistic regression. RESULTS: The mean patient age was 62 years, and 42% were male. There were 813 patients (59%) with a pathological ACH test, 33% for CMD and 26% for epicardial vasospasm. A pathological test was more common in females (70% vs. 43%; p < 0.001). In a multivariable logistic regression model the sex difference was statistically significant with a female-male odds ratio for CMD and epicardial vasospasm of 4.2 (95% confidence interval: 3.1 to 5.5; p < 0.001) and 2.3 (95% confidence interval: 1.7 to 3.1; p < 0.001), respectively. Effort-related symptoms, but neither risk factors nor noninvasive stress tests, contributed to predicting a pathological test. Female patients were more sensitive to acetylcholine with vasomotor dysfunction occurring at lower ACH doses compared with male patients. CONCLUSIONS: Vasomotor dysfunction is frequent in patients with angina and unobstructed coronaries in a European population. Female patients have a higher prevalence of vasomotor dysfunction (especially CMD) compared with male patients. A pathological ACH test was observed at lower ACH doses in women compared with men.

19 Article Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease: The iPOWER Study. 2017

Flintholm Raft, Kristoffer / Frestad, Daria / Michelsen, Marie Mide / Suhrs, Hannah Elena / Rask, Anna Bay / Nilsson, Malin / Hermann, Thomas Steffen / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. ·J Vasc Res · Pubmed #28942444.

ABSTRACT: PURPOSE: We investigated whether impaired flow-mediated dilation (FMD) and plasma biomarkers reflecting endothelial dysfunction are associated with coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease (CAD). METHODS: Patients (n = 194) were randomly selected women with angina pectoris and no obstructive CAD (<50% stenosis). A reference population of asymptomatic women without CAD (n = 25) was included. We measured FMD in the brachial artery by high-resolution ultrasound. Coronary flow velocity reserve (CFVR) was assessed by transthoracic Doppler flow echocardiography (TTDE) of the left anterior descending artery during rest and high-dose dipyridamole infusion. CMD was defined as CFVR <2. RESULTS: FMD and CFVR were measured in 128 patients and 21 controls. Mean (SD) age was 64.5 (8.9) years, mean CFVR was 2.3 (2.0-2.7), and mean FMD was 8.4% (4.8%) in angina patients. Angina patients had a higher risk factor burden compared with the reference population. Measures of peripheral endothelial dysfunction and endothelial plasma biomarkers did not differ according to angina or CFVR. CFVR and FMD did not correlate (Spearman ρ = -0.07, p = 0.45). CONCLUSIONS: FMD and biomarkers of endothelial dysfunction did not identify individuals with CMD assessed as impaired CFVR by TTDE in women with angina and no obstructive CAD.

20 Article Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease: the iPOWER study. 2016

Mygind, Naja Dam / Michelsen, Marie Mide / Pena, Adam / Qayyum, Abbas Ali / Frestad, Daria / Christensen, Thomas Emil / Ghotbi, Adam Ali / Dose, Nynne / Faber, Rebekka / Vejlstrup, Niels / Hasbak, Philip / Kjaer, Andreas / Prescott, Eva / Kastrup, Jens / Anonymous3770886. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. naja.dam.mygind.02@regionh.dk. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. naja.dam.mygind.02@regionh.dk. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. ·J Cardiovasc Magn Reson · Pubmed #27809867.

ABSTRACT: BACKGROUND: Even in absence of obstructive coronary artery disease women with angina pectoris have a poor prognosis possibly due to coronary microvascular disease. Coronary microvascular disease can be assessed by transthoracic Doppler echocardiography measuring coronary flow velocity reserve (CFVR) and by positron emission tomography measuring myocardial blood flow reserve (MBFR). Diffuse myocardial fibrosis can be assessed by cardiovascular magnetic resonance (CMR) T1 mapping. We hypothesized that coronary microvascular disease is associated with diffuse myocardial fibrosis. METHODS: Women with angina, a clinically indicated coronary angiogram with <50 % stenosis and no diabetes were included. CFVR was measured using dipyridamole (0.84 mg/kg) and MBFR using adenosine (0.84 mg/kg). Focal fibrosis was assessed by 1.5 T CMR late gadolinium enhancement (0.1 mmol/kg) and diffuse myocardial fibrosis by T1 mapping using a modified Look-Locker pulse sequence measuring T1 and extracellular volume fraction (ECV). RESULTS: CFVR and CMR were performed in 64 women, mean (SD) age 62.5 (8.3) years. MBFR was performed in a subgroup of 54 (84 %) of these women. Mean native T1 was 1023 (86) and ECV (%) was 33.7 (3.5); none had focal fibrosis. Median (IQR) CFVR was 2.3 (1.9; 2.7), 23 (36 %) had CFVR < 2 indicating coronary microvascular disease, and median MBFR was 2.7 (2.2; 3.0) and 19 (35 %) had a MBFR value below 2.5. No significant correlations were found between CFVR and ECV or native T1 (R CONCLUSION: In women with angina and no obstructive coronary artery disease we found no association between measures of coronary microvascular disease and myocardial fibrosis, suggesting that myocardial ischemia induced by coronary microvascular disease does not elicit myocardial fibrosis in this population. The examined parameters seem to provide independent information about myocardial and coronary disease.

21 Article Coronary flow velocity reserve by echocardiography: feasibility, reproducibility and agreement with PET in overweight and obese patients with stable and revascularized coronary artery disease. 2016

Olsen, Rasmus Huan / Pedersen, Lene Rørholm / Snoer, Martin / Christensen, Thomas Emil / Ghotbi, Adam Ali / Hasbak, Philip / Kjaer, Andreas / Haugaard, Steen B / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Building 67, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark. rasmus.huan.olsen@regionh.dk. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Building 67, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark. · Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Internal Medicine and Clinical Research Centre, Amager and Hvidovre Hospitals, University of Copenhagen, Copenhagen, Denmark. ·Cardiovasc Ultrasound · Pubmed #27267255.

ABSTRACT: BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography of the LAD is used to assess microvascular function but validation studies in clinical settings are lacking. We aimed to assess feasibility, reproducibility and agreement with myocardial flow reserve (MFR) measured by PET in overweight and obese patients. METHODS: Participants with revascularized coronary artery disease were examined by CFVR. Subgroups were examined by repeated CFVR (reproducibility) or Rubidium-82-PET (agreement). To account for time variation, results were computed for scans performed within a week (1-week) and for all scans regardless of time gap (total) and to account for scar tissue for patients with and without previous myocardial infarction (MI). RESULTS: Eighty-six patients with median BMI 30.9 (IQR 29.4-32.9) kg × m(-2) and CFVR 2.29 (1.90-2.63) were included. CFVR was feasible in 83 (97 %) using a contrast agent in 14 %. For reproducibility overall (n = 21) limits of agreement (LOA) were (-0.75;0.71), within-subjects coefficient of variation (CV) 11 %, and reliability 0.84. For reproducibility within 1-week (n = 13) LOA were (-0.33;0.25), within-subjects CV 5 %, and reliability 0.97. Agreement with MFR of the LAD territory (n = 35) was without significant bias and overall LOA were (-1.40;1.46). Agreement was best for examinations performed within 1-week of participants without MI of the LAD-territory (n = 12); LOA = (-0.68;0.88). CONCLUSIONS: CFVR was highly feasible with a good reproducibility on par with other contemporary measures applied in cardiology. Agreement with MFR was acceptable, though discrepancy related to prior MI has to be considered. CFVR of LAD is a valid tool in overweight and obese patients.

22 Article Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study. 2016

Mygind, Naja Dam / Michelsen, Marie Mide / Pena, Adam / Frestad, Daria / Dose, Nynne / Aziz, Ahmed / Faber, Rebekka / Høst, Nis / Gustafsson, Ida / Hansen, Peter Riis / Hansen, Henrik Steen / Bairey Merz, C Noel / Kastrup, Jens / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark naja.dam.mygind@regionh.dk ndmygind@dadlnet.dk. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. · Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA. ·J Am Heart Assoc · Pubmed #27068634.

ABSTRACT: BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. METHODS AND RESULTS: After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary artery stenosis (<50%) were consecutively included. Mean age (SD) was 62.1 (9.7). Assessment included demographic and clinical data, blood samples, questionnaires, and transthoracic echocardiography during rest and high-dose dipyridamole (0.84 mg/kg) with measurement of coronary flow velocity reserve (CFVR) by Doppler examination of the left anterior descending coronary artery. CFVR was successfully measured in 919 (95%) women. Median (IQR) CFVR was 2.33 (1.98-2.76), and 241 (26%) had markedly impaired CFVR (<2). In multivariable regression analysis, predictors of impaired CFVR were age (P<0.01), hypertension (P=0.02), current smoking (P<0.01), elevated heart rate (P<0.01), and low high-density lipoprotein cholesterol (P=0.02), but these variables explained only a little of the CFVR variation (r(2)=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing. CONCLUSION: Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation of these women. Symptom characteristics and results from stress testing did not identify individuals with impaired CFVR.

23 Article Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD: The iPOWER Study. 2016

Michelsen, Marie Mide / Mygind, Naja Dam / Pena, Adam / Aziz, Ahmed / Frestad, Daria / Høst, Nis / Prescott, Eva / Anonymous500864. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. Electronic address: marie.mide.michelsen@regionh.dk. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. ·JACC Cardiovasc Imaging · Pubmed #27056160.

ABSTRACT: OBJECTIVES: This study investigated whether digital reactive hyperemia index (RHI) measured by digital pulse amplitude tonometry is a sensitive indicator of coronary microvascular dysfunction (CMD). BACKGROUND: CMD is an early marker of cardiovascular disease. However, CMD is a complex diagnosis and consists of multiple abnormalities of the coronary circulation. Impaired RHI is a noninvasive measure of peripheral vascular dysfunction that can identify individuals with acetylcholine induced coronary vascular dysfunction. It is largely unknown whether there is also an association between RHI and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). METHODS: We included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (<50%). CFVR was measured by transthoracic pulsed wave Doppler echocardiography during dipyridamole infusion (0.84 mg/kg). RHI was assessed by digital pulse amplitude tonometry. Participants were categorized in 3 RHI and 3 CFVR groups. We examined the association between CFVR and RHI and the distribution of cardiovascular risk factors between the CFVR and RHI groups. RESULTS: CFVR and RHI were successfully measured in 322 participants. Median CFVR was 2.3 (interquartile range: 2.0 to 2.8) and median RHI was 2.1 (interquartile range: 1.6 to 2.6). No correlation was found between CFVR and RHI (Spearman's rho = -0.067, p = 0.23), and mean RHI did not differ between CFVR categories (p = 0.39). Participants with low CFVR were significantly older and had a significantly greater burden of hypertension, whereas participants with an impaired RHI had a higher body mass index and were more likely to have diabetes and be current smokers. CONCLUSIONS: RHI does not identify individuals with CMD assessed as impaired CFVR by dipyridamole stress echocardiography in women with no obstructive coronary artery disease. The two methods are likely to identify different aspects of vascular pathology, as indicated by the different association with cardiovascular risk factors.

24 Article Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality. 2016

Michelsen, Marie M / Pena, Adam / Mygind, Naja D / Frestad, Daria / Gustafsson, Ida / Hansen, Henrik S / Kastrup, Jens / Bech, Jan / Høst, Nis / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: marie.mide.michelsen@regionh.dk. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. ·J Am Soc Echocardiogr · Pubmed #27038514.

ABSTRACT: BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography is a noninvasive measure of microvascular function, but it has not achieved widespread use, mainly because of concerns of validity and feasibility. The aim of this study was to describe the feasibility and factors associated with the quality of CFVR obtained in a large prospective study of women suspected of having microvascular disease. METHODS: Women with angina-like chest pain and no obstructive coronary artery disease on coronary angiography (<50% stenosis) were consecutively examined by transthoracic Doppler echocardiography of the left anterior descending coronary artery to measure CFVR (n = 947). Quality was evaluated on the basis of (1) identification of the left anterior descending coronary artery, (2) maintained probe position throughout the examination, (3) visibility and configuration of the left anterior descending coronary artery in two-dimensional color Doppler mode, and (4) gradual, consistent increases of characteristic, well-defined flow velocity curves in pulsed-wave mode. RESULTS: The mean age (SD) was 62.1 ± 9.7 years. On the basis of the evaluations, patients were divided into four groups according to quality score: nonfeasible (n = 28 [3%]), low quality (n = 80 [8%]), medium quality (n = 451 [48%]), and high quality (n = 388 [41%]). Quality score was associated with diabetes (P < .01), body mass index (P = .02), waist circumference (P = .05), nonsignificant atherosclerosis on coronary angiography (P = .03), and operator experience (P < .01). Low examination quality was associated with lower CFVR (P = .03), also after multivariate adjustment. CONCLUSIONS: Transthoracic Doppler echocardiographic measurement of CFVR is highly feasible and of good quality in experienced hands. However, CFVR is possibly underestimated when examination quality is low. Awareness of pitfalls and potential bias may improve the validity and interpretation of the measures obtained.

25 Article Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease: A randomized trial. 2016

Pedersen, Lene Rørholm / Olsen, Rasmus Huan / Anholm, Christian / Walzem, Rosemary L / Fenger, Mogens / Eugen-Olsen, Jesper / Haugaard, Steen Bendix / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: lrpedersen@gmail.com. · Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Internal Medicine, Hvidovre and Amager University Hospitals, University of Copenhagen, Copenhagen, Denmark. · Faculty of Nutrition, Texas A&M University, College Station, TX, USA. · Department of Medical Biochemistry, Genetics and Molecular Biochemistry, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. ·Atherosclerosis · Pubmed #26803431.

ABSTRACT: BACKGROUND: Dyslipidemia and low-grade inflammation are integral in the pathogenesis of atherosclerosis. We aim to compare the effects of a considerable weight loss and intensive exercise training on lipid atherogenicity and low-grade inflammation in a high-risk population with coronary artery disease (CAD). METHODS: Seventy non-diabetic participants with CAD, BMI 28-40 kg/m(2), age 45-75 years were randomized to 12 weeks' aerobic interval training (AIT) at 85-90% of peak heart rate three times/week or a low energy diet (LED, 800-1000 kcal/day) for 8-10 weeks followed by 2-4 weeks' weight maintenance diet. Lipid profile atherogenicity was described using lipoprotein particle size and density profiling. Low-grade inflammation was evaluated by tumor necrosis factor alpha (TNFα), C-reactive protein, interleukin 6 and soluble urokinase plasminogen activator receptor. RESULTS: Twenty-six (74%) AIT and 29 (83%) LED participants completed intervention per protocol. AIT and LED decreased total (AIT: -518 {-906;-129},P = 0.011, LED: -767 {-1128:-406},P < 0.001) and low-density lipoprotein (LDL, AIT: -186 {-306;-65},P = 0.004, LED: -277 {-433;-122},P < 0.001) assessed as the area under the density profile curve. LED was superior to AIT in decreasing atherogenicity reflected by increased LDL (between-group: 1.0 Å {0.4; 1.7},P = 0.003) and high-density lipoprotein (between-group: 1.2 Å {0.2; 2.4},P = 0.026) particle size and a decreased proportion of total lipoprotein constituted by the small, dense LDL5 subfraction (between-group: -5.0% {-8.4;-1.7},P = 0.004). LED decreased TNFα (9.5% {-15.8;-2.6},P = 0.009). No changes were seen following AIT. CONCLUSION: LED and AIT decreased total and LDL lipoprotein. LED was superior in decreasing atherogenicity assessed by a shift in density profile and increased particle size. Effect on low-grade inflammation was limited.

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