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Coronary Artery Disease: HELP
Articles from Aarhus University Hospital
Based on 189 articles published since 2008
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These are the 189 published articles about Coronary Artery Disease that originated from Aarhus University Hospital during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Guideline SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). 2016

Abbara, Suhny / Blanke, Philipp / Maroules, Christopher D / Cheezum, Michael / Choi, Andrew D / Han, B Kelly / Marwan, Mohamed / Naoum, Chris / Norgaard, Bjarne L / Rubinshtein, Ronen / Schoenhagen, Paul / Villines, Todd / Leipsic, Jonathon. ·University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. · University of Texas Southwestern Medical Center, Dallas, TX, United States. · Cardiology Service Ft. Belvoir Community Hospital, Ft. Belvoir, VA, United States. · Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington DC, United States. · Minneapolis Heart Institute and Children's Heart Clinic, Minneapolis, MN, United States. · Cardiology Department, University Hospital, Erlangen, Germany. · Concord Hospital, The University of Sydney, Sydney, Australia. · Department of Cardiology B, Aarhus University Hospital-Skejby, Aarhus N, Denmark. · Lady Davis Carmel Medical Center & Rappaport School of Medicine- Technion- IIT, Haifa, Israel. · Cardiovascular Imaging, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States. · Walter Reed National Military Medical Center, Bethesda, MD, United States. ·J Cardiovasc Comput Tomogr · Pubmed #27780758.

ABSTRACT: In response to recent technological advancements in acquisition techniques as well as a growing body of evidence regarding the optimal performance of coronary computed tomography angiography (coronary CTA), the Society of Cardiovascular Computed Tomography Guidelines Committee has produced this update to its previously established 2009 "Guidelines for the Performance of Coronary CTA" (1). The purpose of this document is to provide standards meant to ensure reliable practice methods and quality outcomes based on the best available data in order to improve the diagnostic care of patients. Society of Cardiovascular Computed Tomography Guidelines for the Interpretation is published separately (2). The Society of Cardiovascular Computed Tomography Guidelines Committee ensures compliance with all existing standards for the declaration of conflict of interest by all authors and reviewers for the purpose ofclarity and transparency.

2 Editorial Angiography based quantitative flow ratio in coronary artery disease: Mimic of FFR - Ready for clinical use? 2019

Nørgaard, B L / Ko, B. ·Department Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia. ·Int J Cardiol · Pubmed #30612849.

ABSTRACT: -- No abstract --

3 Editorial Keep bifurcation stenting simple and cheap or controlled and optimised? 2018

Holm, Niels Ramsing / Andreasen, Lene Nyhus / Christiansen, Evald H. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. ·EuroIntervention · Pubmed #29400279.

ABSTRACT: -- No abstract --

4 Editorial Coronary MR Imaging: Moving From Lumenography to Plaque Assessment. 2015

Botnar, René M / Kim, Won Yong. ·Division of Imaging Sciences and Biomedical Engineering, King's College London, BHF Centre of Research Excellence and Biomedical Research Centre of Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: rene.botnar@kcl.ac.uk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. ·JACC Cardiovasc Imaging · Pubmed #26481840.

ABSTRACT: -- No abstract --

5 Editorial Unmatched Results After Double Kissing Crush Stenting Technique in Distal Left Main Coronary Artery Treatment? 2015

Thuesen, Leif / Holm, Niels Ramsing. ·Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. Electronic address: leif.thuesen@ki.au.dk. · Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. ·JACC Cardiovasc Interv · Pubmed #26315737.

ABSTRACT: -- No abstract --

6 Editorial Coronary CT angiography in clinical practice: experiences from Denmark. 2014

Nørgaard, Bjarne Linde. ·Department of Cardiology B, Aarhus University Hospital Skejby , Aarhus C , Denmark. ·Scand Cardiovasc J · Pubmed #25142798.

ABSTRACT: -- No abstract --

7 Review Current Evidence in Cardiothoracic Imaging: Computed Tomography-derived Fractional Flow Reserve in Stable Chest Pain. 2019

Schwartz, Fides R / Koweek, Lynne M / Nørgaard, Bjarne L. ·Department of Radiology, Duke University Medical Center, Durham, NC. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. ·J Thorac Imaging · Pubmed #30376481.

ABSTRACT: High-accuracy diagnostic imaging is needed to diagnose and manage coronary artery disease as well as to allow risk stratification for future events. Advancements in multidetector computed tomography and image postprocessing allow for routine computed tomography coronary angiography to provide anatomic luminal assessment similar to invasive coronary angiography, and, similarly, computational fractional flow reserve derived from computed tomography facilitates determination of hemodynamically relevant stenosis comparable to invasive fractional flow reserve. In this review article, we describe the diagnostic performance and the potential impact of fractional flow reserve derived from computed tomography in clinical practice.

8 Review Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. 2018

Head, Stuart J / Milojevic, Milan / Daemen, Joost / Ahn, Jung-Min / Boersma, Eric / Christiansen, Evald H / Domanski, Michael J / Farkouh, Michael E / Flather, Marcus / Fuster, Valentin / Hlatky, Mark A / Holm, Niels R / Hueb, Whady A / Kamalesh, Masoor / Kim, Young-Hak / Mäkikallio, Timo / Mohr, Friedrich W / Papageorgiou, Grigorios / Park, Seung-Jung / Rodriguez, Alfredo E / Sabik, Joseph F / Stables, Rodney H / Stone, Gregg W / Serruys, Patrick W / Kappetein, Arie Pieter. ·Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: s.head@erasmusmc.nl. · Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. · Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. · Icahn School of Medicine at Mount Sinai, New York, NY, USA; Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, ON, Canada. · Norwich Medical School University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK. · Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Stanford University School of Medicine, Stanford, CA, USA. · Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. · Richard L Roudebush VA Medical Center, Indianapolis, IN, USA. · Department of Cardiology, Oulu University Hospital, Oulu, Finland. · Department of Cardiac Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany. · Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands. · Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina. · Department Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. · Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK. · Columbia University Medical Center and the Center for Clinical Trials, Cardiovascular Research Foundation, New York, NY, USA. · Imperial College London, London, UK. ·Lancet · Pubmed #29478841.

ABSTRACT: BACKGROUND: Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies. METHODS: We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality. In a collaborative, pooled analysis of individual patient data from the identified trials, we estimated all-cause mortality up to 5 years using Kaplan-Meier analyses and compared PCI with CABG using a random-effects Cox proportional-hazards model stratified by trial. Consistency of treatment effect was explored in subgroup analyses, with subgroups defined according to baseline clinical and anatomical characteristics. FINDINGS: We included 11 randomised trials involving 11 518 patients selected by heart teams who were assigned to PCI (n=5753) or to CABG (n=5765). 976 patients died over a mean follow-up of 3·8 years (SD 1·4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score was 26·0 (SD 9·5), with 1798 (22·1%) of 8138 patients having a SYNTAX score of 33 or higher. 5 year all-cause mortality was 11·2% after PCI and 9·2% after CABG (hazard ratio [HR] 1·20, 95% CI 1·06-1·37; p=0·0038). 5 year all-cause mortality was significantly different between the interventions in patients with multivessel disease (11·5% after PCI vs 8·9% after CABG; HR 1·28, 95% CI 1·09-1·49; p=0·0019), including in those with diabetes (15·5% vs 10·0%; 1·48, 1·19-1·84; p=0·0004), but not in those without diabetes (8·7% vs 8·0%; 1·08, 0·86-1·36; p=0·49). SYNTAX score had a significant effect on the difference between the interventions in multivessel disease. 5 year all-cause mortality was similar between the interventions in patients with left main disease (10·7% after PCI vs 10·5% after CABG; 1·07, 0·87-1·33; p=0·52), regardless of diabetes status and SYNTAX score. INTERPRETATION: CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. No benefit for CABG over PCI was seen in patients with left main disease. Longer follow-up is needed to better define mortality differences between the revascularisation strategies. FUNDING: None.

9 Review Coronary CT Angiography Derived Fractional Flow Reserve: The Game Changer in Noninvasive Testing. 2017

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

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

10 Review Coronary Artery Calcium Scoring: Is It Time for a Change in Methodology? 2017

Blaha, Michael J / Mortensen, Martin Bødtker / Kianoush, Sina / Tota-Maharaj, Rajesh / Cainzos-Achirica, Miguel. ·Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. Electronic address: mblaha1@jhmi.edu. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Florida Heart and Vascular Multi-Specialty Group, Leesburg, Florida. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; IDIBELL-Bellvitge Biomedical Research Institute, Barcelona, Spain; RTI Health Solutions, Barcelona, Spain. ·JACC Cardiovasc Imaging · Pubmed #28797416.

ABSTRACT: Quantification of coronary artery calcium (CAC) has been shown to be reliable, reproducible, and predictive of cardiovascular risk. Formal CAC scoring was introduced in 1990, with early scoring algorithms notable for their simplicity and elegance. Yet, with little evidence available on how to best build a score, and without a conceptual model guiding score development, these scores were, to a large degree, arbitrary. In this review, we describe the traditional approaches for clinical CAC scoring, noting their strengths, weaknesses, and limitations. We then discuss a conceptual model for developing an improved CAC score, reviewing the evidence supporting approaches most likely to lead to meaningful score improvement (for example, accounting for CAC density and regional distribution). After discussing the potential implementation of an improved score in clinical practice, we follow with a discussion of the future of CAC scoring, asking the central question: do we really need a new CAC score?

11 Review Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4,686 patients. 2017

Palmerini, Tullio / Serruys, Patrick / Kappetein, Arie Pieter / Genereux, Philippe / Riva, Diego Della / Reggiani, Letizia Bacchi / Christiansen, Evald Høj / Holm, Niels R / Thuesen, Leif / Makikallio, Timo / Morice, Marie Claude / Ahn, Jung-Min / Park, Seung-Jung / Thiele, Holger / Boudriot, Enno / Sabatino, Mario / Romanello, Mattia / Biondi-Zoccai, Giuseppe / Cavalcante, Raphael / Sabik, Joseph F / Stone, Gregg W. ·Polo Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy. · International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom. · Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Morristown Medical Center, Morristown, NJ. · Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Oulu University Hospital, Oulu, Finland. · MC Moriec Ramsay Générale de Santé, ICPS, Massy, France. · The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. · University Heart Center Lübeck and the German Center for Cardiovascular Research (DZHK), Lübeck, Germany. · Department of Internal Medicine/Cardiology, University Heart Center, Leipzig, Germany. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · The Cleveland Clinic Foundation, Cleveland, OH. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY. Electronic address: gs2184@columbia.edu. ·Am Heart J · Pubmed #28760214.

ABSTRACT: Some but not all randomized controlled trials (RCT) have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents may be an acceptable alternative to coronary artery bypass grafting (CABG) surgery for the treatment of unprotected left main coronary artery disease (ULMCAD). We therefore aimed to compare the risk of all-cause mortality between PCI and CABG in patients with ULMCAD in a pairwise meta-analysis of RCT. METHODS: Randomized controlled trials comparing PCI vs CABG for the treatment of ULMCAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. RESULTS: Six trials including 4,686 randomized patients were identified. After a median follow-up of 39 months, there were no significant differences between PCI vs CABG in the risk of all-cause mortality (hazard ratio [HR] 0.99, 95% CI 0.76-1.30) or cardiac mortality. However, a significant interaction for cardiac mortality (P CONCLUSIONS: In patients undergoing revascularization for ULMCAD, PCI was associated with similar rates of mortality compared with CABG at a median follow-up of 39 months, but with an interaction effect suggesting relatively lower mortality with PCI in patients with low SYNTAX score and relatively lower mortality with CABG in patients with high SYNTAX score. Both procedures resulted in similar long-term composite rates of death, myocardial infarction, or stroke, with PCI offering an early safety advantage and CABG demonstrating greater durability.

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

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

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

13 Review Antithrombotic strategies for preventing long-term major adverse cardiovascular events in patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention. 2017

Pareek, Manan / Bhatt, Deepak L / Ten Berg, Jürrien M / Kristensen, Steen D / Grove, Erik L. ·a Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School , Boston , MA , USA. · b Cardiology Section, Department of Internal Medicine , Holbaek Hospital , Holbaek , Denmark. · c Department of Cardiology , St. Antonius Hospital , Nieuwegein , The Netherlands. · d Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark. · e Faculty of Health , Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark. ·Expert Opin Pharmacother · Pubmed #28489475.

ABSTRACT: INTRODUCTION: Balancing the risk of recurrent ischemia and bleeding among patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention (PCI) is challenging. Postprocedural antithrombotic therapy aims to reduce the risk related to coronary artery disease, stent placement, and atrial fibrillation, with acceptable risks of bleeding. Areas covered: This review summarizes evidence and recommendations related to long-term antithrombotic strategies in such patients. An overview of the findings from recent meta-analyses and select observational studies is provided, and important completed and ongoing randomized trials are described in detail. Recommendations pertaining to treatment intensity and duration, including the choice of specific anticoagulant and antiplatelet agents, are given. Expert opinion: Triple therapy (oral anticoagulation with dual antiplatelet therapy) is associated with an increased bleeding risk compared with double therapy (oral anticoagulation with a single antiplatelet agent), but double therapy does not appear to be associated with an increased risk of recurrent ischemia or death. Completed trials make a compelling case for double therapy with clopidogrel, not aspirin, when compared with full-intensity triple antithrombotic therapy. We believe that double therapy with an anticoagulant and clopidogrel should generally be favored instead of triple antithrombotic therapy.

14 Review Treatment of Bifurcation Lesions by Bail-Out TAP or Culotte: Lost in Translation? 2017

Burzotta, Francesco / Lefevre, Thierry / Lassen, Jens Flensted / Holm, Niels Ramsing / Stankovic, Goran. ·Institute of Cardiology, Catholic University of the Sacred Heart, 00168 Rome. Italy. · Ramsay-Generale de Sante, Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques Cartier, Massy. France. · Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen. Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus N. Denmark. · Department of Cardiology, Clinical Center of Serbia and Medical Faculty, University of Belgrade, Belgrade. Serbia. ·Rev Recent Clin Trials · Pubmed #28462716.

ABSTRACT: BACKGROUND: Coronary bifurcated lesions (CBL) represent a hot topic of interventional cardiology. Provisional stenting, i.e. implantation of a drug-eluting (DES) in the main branch followed by side-branch (SB) intervention in case of suboptimal SB result, represents the gold standard to treat the vast majority of CBL undergoing percutaneous coronary interventions (PCI). The best technique for bail-out SB stenting has not been established. Prospective randomized trials comparing different stenting techniques may help provide important insights regarding the best way to conduct PCI in patients with CBL. METHODS: The recently published Bifurcations Bad Krozingen (BBK) II trial is the last important randomized study in the field of bifurcation PCI and is focused on the search for the best management of those patients with suboptimal SB result during provisional stenting. Two different SB implantation strategies after provisional stenting have been compared. In the present manuscript, we employed BBK II results in the context of available literature highlighting important specific features of the study with main emphasis on patient selection process and techniques applied.

15 Review A systematic review of imaging anatomy in predicting functional significance of coronary stenoses determined by fractional flow reserve. 2017

Chu, Miao / Dai, Neng / Yang, Junqing / Westra, Jelmer / Tu, Shengxian. ·Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China. · Cardiovascular Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China. · The 3rd Division of Cardiology, Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, No.106, 2nd Zhongshan Road, Yuexiu district, Guangzhou, Guangdong, 510080, China. whyn2000@163.com. · Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. · Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China. sxtu@sjtu.edu.cn. ·Int J Cardiovasc Imaging · Pubmed #28265791.

ABSTRACT: Fractional flow reserve (FFR) is the current gold standard to assess the physiological significance of coronary stenoses. With the development of coronary imaging techniques, several anatomic parameters have been investigated in vivo and their associations with FFR have been studied. The aim of this review is to summarize the accuracy of anatomic parameters derived by the present coronary imaging techniques including invasive coronary angiography, coronary computed tomography angiography, intravascular ultrasound and optical coherence tomography, in predicting a significant FFR. The impact of patient characteristics, lesion locations, variability of FFR and imaging resolution on the predictive ability are discussed.

16 Review A novel approach to diagnosing coronary artery disease: acoustic detection of coronary turbulence. 2017

Thomas, Joseph L / Winther, Simon / Wilson, Robert F / Bøttcher, Morten. ·Division of Cardiology, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 405, Torrance, CA, 90509, USA. jthomas@labiomed.org. · Department of Cardiology B, Aarhus University Hospital, Aarhus N, Denmark. · Division of Cardiology, University of Minnesota School of Medicine, Minneapolis, MN, USA. · Cardiac Imaging Center, Hospital Unit West, Herning, Denmark. ·Int J Cardiovasc Imaging · Pubmed #27581390.

ABSTRACT: Atherosclerotic disease within coronary arteries causes disruption of normal, laminar flow and generates flow turbulence. The characteristic acoustic waves generated by coronary turbulence serve as a novel diagnostic target. The frequency range and timing of microbruits associated with obstructive coronary artery disease (CAD) have been characterized. Technological advancements in sensor, data filtering and analytic capabilities may allow use of intracoronary turbulence for diagnostic and risk stratification purposes. Acoustic detection (AD) systems are based on the premise that the faint auditory signature of obstructive CAD can be isolated and analyzed to provide a new approach to noninvasive testing. The cardiac sonospectrographic analyzer, CADence, and CADScore systems are early-stage, investigational and commercialized examples of AD systems, with the latter two currently undergoing clinical testing with validation of accuracy using computed tomography and invasive angiography. Noninvasive imaging accounts for a large percentage of healthcare expenditures for cardiovascular disease in the developed world, and the growing burden of CAD will disproportionately affect areas in the developing world. AD is a portable, radiation-free, cost-effective method with the potential to provide accurate diagnosis or exclusion of significant CAD. AD represents a model for digital, miniaturized, and internet-connected diagnostic technologies.

17 Review Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis. 2017

Danad, Ibrahim / Szymonifka, Jackie / Twisk, Jos W R / Norgaard, Bjarne L / Zarins, Christopher K / Knaapen, Paul / Min, James K. ·Department of Radiology, Weill Cornell Medical College, New York, NY, USA. · Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA. · Department of Epidemiology and Biostatistics, VU University Medical Center, VU University, Amsterdam, The Netherlands. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. · HeartFlow, Inc., Redwood City, CA, USA. · Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. ·Eur Heart J · Pubmed #27141095.

ABSTRACT: Aims: The aim of this study was to determine the diagnostic performance of single-photon emission computed tomography (SPECT), stress echocardiography (SE), invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), fractional flow reserve (FFR) derived from CCTA (FFRCT), and cardiac magnetic resonance (MRI) imaging when directly compared with an FFR reference standard. Method and results: PubMed and Web of Knowledge were searched for investigations published between 1 January 2002 and 28 February 2015. Studies performing FFR in at least 75% of coronary vessels for the diagnosis of ischaemic coronary artery disease (CAD) were included. Twenty-three articles reporting on 3788 patients and 5323 vessels were identified. Meta-analysis was performed for pooled sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratio, and summary receiver operating characteristic curves. In contrast to ICA, CCTA, and FFRCT reports, studies evaluating SPECT, SE, and MRI were largely retrospective, single-centre and with generally smaller study samples. On a per-patient basis, the sensitivity of CCTA (90%, 95% CI: 86-93), FFRCT (90%, 95% CI: 85-93), and MRI (90%, 95% CI: 75-97) were higher than for SPECT (70%, 95% CI: 59-80), SE (77%, 95% CI: 61-88), and ICA (69%, 95% CI: 65-75). The highest and lowest per-patient specificity was observed for MRI (94%, 95% CI: 79-99) and for CCTA (39%, 95% CI: 34-44), respectively. Similar specificities were noted for SPECT (78%, 95% CI: 68-87), SE (75%, 95% CI: 63-85), FFRCT (71%, 95% CI: 65-75%), and ICA (67%, 95% CI: 63-71). On a per-vessel basis, the highest sensitivity was for CCTA (pooled sensitivity, 91%: 88-93), MRI (91%: 84-95), and FFRCT (83%, 78-87), with lower sensitivities for ICA (71%, 69-74), and SPECT (57%: 49-64). Per-vessel specificity was highest for MRI (85%, 79-89), FFRCT (78%: 78-81), and SPECT (75%: 69-80), whereas ICA (66%: 64-68) and CCTA (58%: 55-61) yielded a lower specificity. Conclusions: In this meta-analysis comparing cardiac imaging methods directly to FFR, MRI had the highest performance for diagnosis of ischaemia-causing CAD, with lower performance for SPECT and SE. Anatomic methods of CCTA and ICA yielded lower specificity, with functional assessment of coronary atherosclerosis by SE, SPECT, and FFRCT improving accuracy.

18 Review Noninvasive fractional flow reserve derived from coronary computed tomography angiography for identification of ischemic lesions: a systematic review and meta-analysis. 2016

Wu, Wen / Pan, Dao-Rong / Foin, Nicolas / Pang, Si / Ye, Peng / Holm, Niels / Ren, Xiao-Min / Luo, Jie / Nanjundappa, Aravinda / Chen, Shao-Liang. ·Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R. China. · National Heart Research Institute, National Heart Centre Singapore, 169609, Singapore. · Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China. · Department of Cardiology, Aarhus University Hospital, Aarhus, 8000, Denmark. · Division of Vascular Surgery, West Virginia University, Morgantown, 25304, USA. ·Sci Rep · Pubmed #27377422.

ABSTRACT: Detection of coronary ischemic lesions by fractional flow reserve (FFR) has been established as the gold standard. In recent years, novel computer based methods have emerged and they can provide simulation of FFR using coronary artery images acquired from coronary computed tomography angiography (FFRCT). This meta-analysis aimed to evaluate diagnostic performance of FFRCT using FFR as the reference standard. Databases of PubMed, Cochrane Library, EMBASE, Medion and Web of Science were searched. Seven studies met the inclusion criteria, including 833 stable patients (1377 vessels or lesions) with suspected or known coronary artery disease (CAD). The patient-based analysis showed pooled estimates of sensitivity, specificity and diagnostic odds ratio (DOR) for detection of ischemic lesions were 0.89 [95%confidence interval (CI), 0.85-0.93], 0.76 (95%CI, 0.64-0.84) and 26.21 (95%CI, 13.14-52.28). At a per-vessel or per-lesion level, the pooled estimates were as follows: sensitivity 0.84 (95%CI, 0.80-0.87), specificity 0.76 (95%CI, 0.67-0.83) and DOR 16.87 (95%CI, 9.41-30.25). Area under summary receiver operating curves was 0.90 (95%CI, 0.87-0.92) and 0.86 (95%CI, 0.83-0.89) at the two analysis levels, respectively. In conclusion, FFRCT technology achieves a moderate diagnostic performance for noninvasive identification of ischemic lesions in stable patients with suspected or known CAD in comparison to invasive FFR measurement.

19 Review Beyond Stenosis With Fractional Flow Reserve Via Computed Tomography and Advanced Plaque Analyses for the Diagnosis of Lesion-Specific Ischemia. 2016

Cheruvu, Chaitu / Naoum, Christopher / Blanke, Philipp / Norgaard, Bjarne / Leipsic, Jonathon. ·Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark. · Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca. ·Can J Cardiol · Pubmed #27032888.

ABSTRACT: In the treatment of stable coronary artery disease (CAD), the determination of stenosis severity by invasive coronary angiography (ICA) is a critical procedure, and for borderline lesions, the detection of ischemia through invasive fractional flow reserve (FFR) is the gold standard. With advances in computational fluid dynamics, FFR can now be calculated noninvasively using anatomic data from coronary computed tomographic angiography (CCTA). This technique is known as FFR

20 Review Platelets and Antiplatelet Therapy in Patients with Coronary Artery Disease and Diabetes. 2016

Neergaard-Petersen, Søs / Hvas, Anne-Mette / Kristensen, Steen Dalby / Grove, Erik Lerkevang. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark. ·Semin Thromb Hemost · Pubmed #26886397.

ABSTRACT: Patients with diabetes mellitus are at increased risk of cardiovascular events. Despite advances in medical and interventional therapy, cardiovascular morbidity and mortality remains high in patients with diabetes. Although accelerated atherosclerosis has long been recognized as an underlying cause, recent studies suggest that changes in platelets and coagulation also play important roles. Patients with diabetes exhibit a prothrombotic milieu with hyperreactive platelets and coagulation abnormalities. Thus, prevention of cardiovascular events in patients with coronary artery disease (CAD) and diabetes involves a multifactorial approach including treatment of risk factors such as dyslipidemia, obesity, hypertension, hyperglycemia, and hypercoagulation. An impaired response to antiplatelet therapy has been consistently reported and optimization of this therapy seems appropriate to reduce the risk of cardiovascular events in these patients. In this review, platelet abnormalities are summarized together with an update of benefits and limitations of antiplatelet therapy in patients with CAD and diabetes.

21 Review Noninvasive Fractional Flow Reserve Derived From Coronary CT Angiography: Clinical Data and Scientific Principles. 2015

Min, James K / Taylor, Charles A / Achenbach, Stephan / Koo, Bon Kwon / Leipsic, Jonathon / Nørgaard, Bjarne L / Pijls, Nico J / De Bruyne, Bernard. ·Departments of Radiology and Medicine, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York. Electronic address: jkm2001@med.cornell.edu. · HeartFlow, Inc., Redwood City, California; Department of Bioengineering, Stanford University, Stanford, California. · Department of Cardiology, Erlangen University Hospital, Erlangen, Germany. · Department of Medicine, Seoul National University Hospital, Seoul, South Korea. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Medicine, Weill Cornell Medical Center, New York, New York; Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. · Catharina Hospital, Eindhoven, the Netherlands. · Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium. ·JACC Cardiovasc Imaging · Pubmed #26481846.

ABSTRACT: Fractional flow reserve derived from coronary computed tomography angiography enables noninvasive assessment of the hemodynamic significance of coronary artery lesions and coupling of the anatomic severity of a coronary stenosis with its physiological effects. Since its initial demonstration of feasibility of use in humans in 2011, a significant body of clinical evidence has developed to evaluate the diagnostic performance of coronary computed tomography angiography-derived fractional flow reserve compared with an invasive fractional flow reserve reference standard. The purpose of this paper was to describe the scientific principles and to review the clinical data of this technology recently approved by the U.S. Food and Drug Administration.

22 Review The influence of low-grade inflammation on platelets in patients with stable coronary artery disease. 2015

Larsen, Sanne Bøjet / Grove, Erik Lerkevang / Würtz, Morten / Neergaard-Petersen, Søs / Hvas, Anne-Mette / Kristensen, Steen Dalby. ·Steen Dalby Kristensen, MD, DMSc, FESC, Professor, consultant cardiologist, Department of Cardiology, Aarhus University Hospital, DK - 8200 Aarhus, Denmark, Tel.: +45 78452030, Fax: +45 78452260, E-mail: steendk@dadlnet.dk. ·Thromb Haemost · Pubmed #26062929.

ABSTRACT: Inflammation is likely to be involved in all stages of atherosclerosis. Numerous inflammatory biomarkers are currently being studied, and even subtle increases in inflammatory biomarkers have been associated with increased risk of cardiovascular events in patients with coronary artery disease (CAD). Low-grade inflammation may influence both platelet production and platelet activation potentially leading to enhanced platelet aggregation. Thrombopoietin is considered the primary regulator of platelet production, but it likely acts in conjunction with numerous cytokines, of which many have altered levels in CAD. Previous studies have shown that high-sensitive C-reactive protein (CRP) independently predicts increased platelet aggregation in stable CAD patients. Increased levels of CRP, fibrinogen, interleukin-6, stromal cell-derived factor-1, CXC motif ligand 16, macrophage migration inhibitory factor, RANTES, calprotectin, and copeptin have been associated with increased risk of cardiovascular events in CAD patients. Additionally, some of these inflammatory markers have been associated with enhanced platelet activation and aggregation. However, CRP and other inflammatory markers provide only limited additional predictive value to classical risk factors such as smoking, blood pressure, and cholesterol levels. Existing data do not clarify whether inflammation simply accompanies CAD and increased production and aggregation of platelets, or whether a causal relationship exists. In this review, we provide a comprehensive overview of inflammatory markers in stable CAD with particular emphasis on platelet production, activation, and aggregation in CAD patients.

23 Review Aspirin in coronary artery disease: an appraisal of functions and limitations. 2015

Würtz, Morten. ·Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. morten.wurtz@clin.au.dk. ·Dan Med J · Pubmed #25872543.

ABSTRACT: Aspirin (acetylsalicylic acid) is an antiplatelet drug used to treat and prevent coronary artery disease. Aspirin is used more frequently than any other drug in the world, however it does not inhibit platelet function equally well in all patients. The risk of platelet-dependent cardiovascular events is increased in patients, in whom aspirin inhibits platelet function suboptimally. Platelet inhibition with aspirin can be evaluated by use of modern whole blood platelet function tests. The overall aim of this dissertation was to identify and describe functions and limitations of aspirin. We used whole blood platelet aggregometry (Multiplate® Analyzer and VerifyNow® Aspirin) as the primary measure of platelet function. To identify biological mechanisms explaining our findings we also measured a number of biological markers, including markers of cyclooxygenase-1 activity, platelet activation, and platelet turnover. All participants (except healthy individuals in study 1) were treated with non-enteric coated aspirin 75 mg once daily during study participation and received no other drugs affecting platelet function. We used serum TXB2 measurements to verify that all patients were adherent to aspirin. In study 1, we investigated the association between platelet aggregometry results and platelet count, red blood cell count, and white blood cell count. The study population consisted of 417 aspirin-treated patients with stable coronary artery disease and 21 drug-naïve healthy individuals. We found consistent associations between aggregation and platelet count, red blood cell count, and white blood cell count. In particular, platelet count was an independent predictor of platelet aggregation, although generally associations were rather weak. In study 2, we focused on patients previously suffering definite stent thrombosis because these patients may be at a prothrombotic state. We compared levels of platelet aggregation and platelet turnover in 39 patients with previous definite stent thrombosis with levels in 78 patients with stable coronary artery disease. We found that patients with previous definite stent thrombosis displayed increased platelet aggregation and had a tendency towards increased platelet turnover. In study 3, we investigated if the antiplatelet effect of aspirin is sustained through the standard 24-hour dosing interval. We included 50 patients with previous definite stent thrombosis, 100 patients with stable coronary artery disease, and 50 healthy individuals. We found that platelet aggregation increased significantly through the 24-hour dosing interval, and so did cyclooxygenase-1 activity and platelet activation. The increase in platelet aggregation did not differ between groups, but patients with previous definite stent thrombosis had higher levels of platelet turnover indices and thrombopoietin. In study 4, we addressed an ongoing debate concerning potential interactions between antiplatelet drugs and proton pump inhibitors. In patients with coronary artery disease, we investigated if the antiplatelet effect of aspirin was reduced in 54 patients treated with aspirin and a proton pump inhibitor compared to 364 patients treated with aspirin only. We found increased levels of platelet aggregation and platelet activation in patients treated with aspirin and a proton pump inhibitor.

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

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

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

25 Review Mechanisms of plaque formation and rupture. 2014

Bentzon, Jacob Fog / Otsuka, Fumiyuki / Virmani, Renu / Falk, Erling. ·From the Department of Clinical Medicine (J.F.B., E.F.), Aarhus University, and Department of Cardiology (J.F.B., E.F.), Aarhus University Hospital, Aarhus, Denmark · and CVPath Institute Inc, Gaithersburg, MD (F.O., R.V.). ·Circ Res · Pubmed #24902970.

ABSTRACT: Atherosclerosis causes clinical disease through luminal narrowing or by precipitating thrombi that obstruct blood flow to the heart (coronary heart disease), brain (ischemic stroke), or lower extremities (peripheral vascular disease). The most common of these manifestations is coronary heart disease, including stable angina pectoris and the acute coronary syndromes. Atherosclerosis is a lipoprotein-driven disease that leads to plaque formation at specific sites of the arterial tree through intimal inflammation, necrosis, fibrosis, and calcification. After decades of indolent progression, such plaques may suddenly cause life-threatening coronary thrombosis presenting as an acute coronary syndrome. Most often, the culprit morphology is plaque rupture with exposure of highly thrombogenic, red cell-rich necrotic core material. The permissive structural requirement for this to occur is an extremely thin fibrous cap, and thus, ruptures occur mainly among lesions defined as thin-cap fibroatheromas. Also common are thrombi forming on lesions without rupture (plaque erosion), most often on pathological intimal thickening or fibroatheromas. However, the mechanisms involved in plaque erosion remain largely unknown, although coronary spasm is suspected. The calcified nodule has been suggested as a rare cause of coronary thrombosis in highly calcified and tortious arteries in older individuals. To characterize the severity and prognosis of plaques, several terms are used. Plaque burden denotes the extent of disease, whereas plaque activity is an ambiguous term, which may refer to one of several processes that characterize progression. Plaque vulnerability describes the short-term risk of precipitating symptomatic thrombosis. In this review, we discuss mechanisms of atherosclerotic plaque initiation and progression; how plaques suddenly precipitate life-threatening thrombi; and the concepts of plaque burden, activity, and vulnerability.

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