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Mohamed M, Bosserdt M, Wieske V, Dubourg B, Alkadhi H, Garcia MJ, Leschka S, Zimmermann E, Shabestari AA, Nørgaard BL, Meijs MFL, Øvrehus KA, Diederichsen ACP, Knuuti J, Halvorsen BA, Mendoza-Rodriguez V, Wan YL, Bettencourt N, Martuscelli E, Buechel RR, Mickley H, Sun K, Muraglia S, Kaufmann PA, Herzog BA, Tardif JC, Schütz GM, Laule M, Newby DE, Achenbach S, Budoff M, Haase R, Biavati F, Mézquita AV, Schlattmann P, Dewey M. Combination of computed tomography angiography with coronary artery calcium score for improved diagnosis of coronary artery disease: a collaborative meta-analysis of stable chest pain patients referred for invasive coronary angiography. Eur Radiol 2024; 34:2426-2436. [PMID: 37831139 PMCID: PMC10957619 DOI: 10.1007/s00330-023-10223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/29/2023] [Accepted: 07/30/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Coronary computed tomography angiography (CCTA) has higher diagnostic accuracy than coronary artery calcium (CAC) score for detecting obstructive coronary artery disease (CAD) in patients with stable chest pain, while the added diagnostic value of combining CCTA with CAC is unknown. We investigated whether combining coronary CCTA with CAC score can improve the diagnosis of obstructive CAD compared with CCTA alone. METHODS A total of 2315 patients (858 women, 37%) aged 61.1 ± 10.2 from 29 original studies were included to build two CAD prediction models based on either CCTA alone or CCTA combined with the CAC score. CAD was defined as at least 50% coronary diameter stenosis on invasive coronary angiography. Models were built by using generalized linear mixed-effects models with a random intercept set for the original study. The two CAD prediction models were compared by the likelihood ratio test, while their diagnostic performance was compared using the area under the receiver-operating-characteristic curve (AUC). Net benefit (benefit of true positive versus harm of false positive) was assessed by decision curve analysis. RESULTS CAD prevalence was 43.5% (1007/2315). Combining CCTA with CAC improved CAD diagnosis compared with CCTA alone (AUC: 87% [95% CI: 86 to 89%] vs. 80% [95% CI: 78 to 82%]; p < 0.001), likelihood ratio test 236.3, df: 1, p < 0.001, showing a higher net benefit across almost all threshold probabilities. CONCLUSION Adding the CAC score to CCTA findings in patients with stable chest pain improves the diagnostic performance in detecting CAD and the net benefit compared with CCTA alone. CLINICAL RELEVANCE STATEMENT CAC scoring CT performed before coronary CTA and included in the diagnostic model can improve obstructive CAD diagnosis, especially when CCTA is non-diagnostic. KEY POINTS • The combination of coronary artery calcium with coronary computed tomography angiography showed significantly higher AUC (87%, 95% confidence interval [CI]: 86 to 89%) for diagnosis of coronary artery disease compared to coronary computed tomography angiography alone (80%, 95% CI: 78 to 82%, p < 0.001). • Diagnostic improvement was mostly seen in patients with non-diagnostic C. • The improvement in diagnostic performance and the net benefit was consistent across age groups, chest pain types, and genders.
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Affiliation(s)
- Mahmoud Mohamed
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Bosserdt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Dubourg
- Radiology Department, Clinique Saint Augustin, 112-114 avenue d'Arès, 33000, Bordeaux, France
| | - Hatem Alkadhi
- Diagnostic and Interventional, Radiology University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, New York City, NY, USA
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Abbas A Shabestari
- Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus Universtity Hospital, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | | | | | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 333, Taoyuan City, Taiwan
| | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Inner Mongolia Province, Baotou, China
| | | | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Georg M Schütz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Laule
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthew Budoff
- Department of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA
| | - Robert Haase
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Federico Biavati
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health, 10117, Berlin, Germany.
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Hasific S, Rasmussen LM, Dahl JS, Diederichsen ACP. Response by Hasific et al to Letter Regarding Article, "Vitamin K2 and D in Patients With Aortic Valve Calcification: A Randomized Double-Blinded Clinical Trial". Circulation 2023; 148:1269-1270. [PMID: 37844144 DOI: 10.1161/circulationaha.123.066271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Selma Hasific
- Department of Cardiology (S.H., J.S.D., A.C.P.D.), Odense University Hospital, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry, Center for Individualized Medicine in Arterial Diseases (L.M.R.), Odense University Hospital, Denmark
| | - Jordi S Dahl
- Department of Cardiology (S.H., J.S.D., A.C.P.D.), Odense University Hospital, Denmark
| | - Axel C P Diederichsen
- Department of Cardiology (S.H., J.S.D., A.C.P.D.), Odense University Hospital, Denmark
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Diederichsen ACP, Hasific S, Dahl JS. Response by Diederichsen et al to Letter Regarding Article, "Vitamin K2 and D in Patients With Aortic Valve Calcification: A Randomized Double-Blinded Clinical Trial". Circulation 2022; 146:e227-e228. [PMID: 36251786 DOI: 10.1161/circulationaha.122.061691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | - Selma Hasific
- Department of Cardiology, Odense University Hospital, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Denmark
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4
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Wieske V, Walther M, Dubourg B, Alkadhi H, Nørgaard BL, Meijs MFL, Diederichsen ACP, Wan YL, Mickley H, Nikolaou K, Shabestari AA, Halvorsen BA, Martuscelli E, Sun K, Herzog BA, Marcus RP, Leschka S, Garcia MJ, Ovrehus KA, Knuuti J, Mendoza-Rodriguez V, Bettencourt N, Muraglia S, Buechel RR, Kaufmann PA, Zimmermann E, Tardif JC, Budoff MJ, Schlattmann P, Dewey M. Correction to: Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium. Eur Radiol 2022; 32:8052-8053. [PMID: 35467114 DOI: 10.1007/s00330-022-08760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mario Walther
- Department of Fundamental Sciences, Jena University of Applied Sciences, Jena, Germany
| | - Benjamin Dubourg
- Cardiac Imaging Unit, Department of Radiology, Rouen University Hospital, Rouen, France
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Yung-Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou, Inner Mongolia Province, China
| | | | - Roy P Marcus
- Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, New York, NY, USA
| | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | | | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Wieske V, Walther M, Dubourg B, Alkadhi H, Nørgaard BL, Meijs MFL, Diederichsen ACP, Wan YL, Mickley H, Nikolaou K, Shabestari AA, Halvorsen BA, Martuscelli E, Sun K, Herzog BA, Marcus RP, Leschka S, Garcia MJ, Ovrehus KA, Knuuti J, Mendoza-Rodriguez V, Bettencourt N, Muraglia S, Buechel RR, Kaufmann PA, Zimmermann E, Tardif JC, Budoff MJ, Schlattmann P, Dewey M. Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium. Eur Radiol 2022; 32:5233-5245. [PMID: 35267094 PMCID: PMC9279219 DOI: 10.1007/s00330-022-08619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
Objectives There is conflicting evidence about the comparative diagnostic accuracy of the Agatston score versus computed tomography angiography (CTA) in patients with suspected obstructive coronary artery disease (CAD). Purpose To determine whether CTA is superior to the Agatston score in the diagnosis of CAD. Methods In total 2452 patients with stable chest pain and a clinical indication for invasive coronary angiography (ICA) for suspected CAD were included by the Collaborative Meta-analysis of Cardiac CT (COME-CCT) Consortium. An Agatston score of > 400 was considered positive, and obstructive CAD defined as at least 50% coronary diameter stenosis on ICA was used as the reference standard. Results Obstructive CAD was diagnosed in 44.9% of patients (1100/2452). The median Agatston score was 74. Diagnostic accuracy of CTA for the detection of obstructive CAD (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) was significantly higher than that of the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). Among patients with an Agatston score of zero, 17% (101/600) had obstructive CAD. Diagnostic accuracy of CTA was not significantly different in patients with low to intermediate (1 to < 100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). Conclusions Results in our international cohort show CTA to have significantly higher diagnostic accuracy than the Agatston score in patients with stable chest pain, suspected CAD, and a clinical indication for ICA. Diagnostic performance of CTA is not affected by a higher Agatston score while an Agatston score of zero does not reliably exclude obstructive CAD. Key Points • CTA showed significantly higher diagnostic accuracy (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) for diagnosis of coronary artery disease when compared to the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). • Diagnostic performance of CTA was not affected by increased amount of calcium and was not significantly different in patients with low to intermediate (1 to <100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). • Seventeen percent of patients with an Agatston score of zero showed obstructive coronary artery disease by invasive angiography showing absence of coronary artery calcium cannot reliably exclude coronary artery disease. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08619-4.
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Affiliation(s)
- Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mario Walther
- Department of Fundamental Sciences, Jena University of Applied Sciences, Jena, Germany
| | - Benjamin Dubourg
- Cardiac Imaging Unit, Department of Radiology, Rouen University Hospital, Rouen, France
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Yung-Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou, Inner Mongolia Province, China
| | | | - Roy P Marcus
- Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, New York, NY, USA
| | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | | | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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6
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Korsholm SS, Andersson DC, Knudsen JB, Dastmalchi M, Diederichsen ACP, Gerke O, Witting N, Jacobsen S, Pecini R, Friis T, Krogager ME, Lundberg IE, Diederichsen O. Myositis-Specific Autoantibodies and QTc Changes by ECG in Idiopathic Inflammatory Myopathies. Rheumatology (Oxford) 2022; 61:4076-4086. [PMID: 35048961 DOI: 10.1093/rheumatology/keac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate cardiac involvement detected by electrocardiography (ECG) in patients with idiopathic inflammatory myopathies (IIM) and to evaluate possible associations between autoantibody profile and ECG changes in these patients. METHODS In a Scandinavian cross-sectional study, patients were included from two Danish centres and one Swedish centre. Resting 12-lead ECG was investigated in 261 patients with IIM compared with 102 patients with systemic sclerosis (SSc) and 48 healthy controls (HCs). ECG changes were correlated to clinical manifestations and myositis-specific (MSAs) and myositis-associated (MAAs) autoantibodies. RESULTS Patients with IIM had longer mean QTc duration and more frequently presented with prolonged QTc (≥ 450 ms; p= 0.038) compared with HCs. Longer QTc duration was recorded in SSc compared with IIM (433 ± 23 ms vs 426 ± 24 ms, p= 0.011), yet, no significant difference in the fraction with prolonged QTc (SSc: 22%, IIM: 16%; p= 0.19). In multivariable regression analyses, anti-Mi2 (p= 0.01, p= 0.035) and anti-Pl-7 (p= 0.045, p= 0.014) were associated with QTc duration and prolonged QTc in IIM. Elevated CRP was associated with prolonged QTc (p= 0.041). CONCLUSION Presence of QTc abnormalities was as common in patients with IIM as in patients with SSc, including prolonged QTc seen in almost one fifth of the patients. Anti-Mi2, anti-Pl-7, and elevated CRP may serve as biomarkers for cardiac disease in IIM, but needs to be confirmed in a larger prospective study.
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Affiliation(s)
- Sine Søndergaard Korsholm
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (CUH), Rigshospitalet, Denmark, Copenhagen.,Dept of Rheumatology, Odense University Hospital (OUH), Odense, Denmark
| | - Daniel C Andersson
- Dept of Physiology and Pharmacology, Karolinska Institute, Solna, Stockholm, Sweden.,Heart, Vascular and Neurology Theme, Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | - Maryam Dastmalchi
- Division of Rheumatology, Dept of medicine, Solna, Stockholm, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | | | - Oke Gerke
- Dept of Nuclear Medicine, OUH, Odense, Denmark
| | | | - Søren Jacobsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (CUH), Rigshospitalet, Denmark, Copenhagen
| | - Redi Pecini
- Dept of Cardiology, CUH, Copenhagen, Denmark
| | - Tina Friis
- Dept of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ingrid E Lundberg
- Division of Rheumatology, Dept of medicine, Solna, Stockholm, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Ouise Diederichsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (CUH), Rigshospitalet, Denmark, Copenhagen.,Dept of Rheumatology, Odense University Hospital (OUH), Odense, Denmark
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Gerke O, Lindholt JS, Abdo BH, Lambrechtsen J, Frost L, Steffensen FH, Karon M, Egstrup K, Urbonaviciene G, Busk M, Mickley H, Diederichsen ACP. Prevalence and extent of coronary artery calcification in the middle-aged and elderly population. Eur J Prev Cardiol 2021; 28:2048-2055. [PMID: 34179988 DOI: 10.1093/eurjpc/zwab111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 01/21/2023]
Abstract
AIMS Coronary artery calcification (CAC) measured on cardiac computed tomography (CT) is an important risk marker for cardiovascular disease (CVD) and has been included in the prevention guidelines. The aim of this study was to describe CAC score reference values in the middle-aged and elderly population and to develop a freely available CAC calculator. METHODS AND RESULTS All participants from two population-based cardiac CT screening cohorts (DanRisk and DANCAVAS) were included. The CAC score was measured as a part of a screening session. Positive CAC scores were log-transformed and non-parametrically regressed on age for each gender, and percentile curves were transposed according to proportions of zero CAC scores. Men had higher CAC scores than women, and the prevalence and extend of CAC increased steadily with age. An online CAC calculator was developed, http://flscripts.dk/cacscore. After entering sex, age, and CAC score, the CAC score percentile and the coronary age are depicted including a figure with the specific CAC score and 25%, 50%, 75%, and 90% percentiles. The specific CAC score can be compared to the entire background population or only those without prior CVD. CONCLUSION This study provides modern population-based reference values of CAC scores in men and woman and a freely accessible online CAC calculator. Physicians and patients are very familiar with blood pressure and lipids, but unfamiliar with CAC scores. Using the calculator makes it easy to see if a CAC value is low, moderate, or high, when a physician in the future communicate and discusses a CAC score with a patient.
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Affiliation(s)
- Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Jes S Lindholt
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Barzan H Abdo
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Svendborg Hospital, Baagøes Àlle 15 5700 Svendborg, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Falkevej 1, 8600 Silkeborg, Denmark
| | | | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Hospitalsvej, 4800 Nykøbing Falster, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Baagøes Àlle 15 5700 Svendborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Falkevej 1, 8600 Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Axel C P Diederichsen
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark.,Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
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Saleh QW, Diederichsen ACP, Lindholt JS. Ascending Aortic Diameter after Dissection Does Not Reflect Size before Dissection. EJVES Vasc Forum 2020; 49:20-22. [PMID: 33089224 PMCID: PMC7567910 DOI: 10.1016/j.ejvsvf.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Current guidelines for prophylactic resection of ascending aortic aneurysms are based on post-dissection aortic diameter. However, this may not reflect the diameter prior to dissection. Report Pre- and post-dissection aortic diameters were compared in 34 patients with available computerised tomography scans. The median time interval between these scans was 536 days (interquartile range 354 – 1237). Discussion There was a statistically significant difference in diameters from the sinotubular junction to the proximal abdominal aorta, the largest was in the ascending aorta with a mean of 7.6 mm (standard deviation 4.5). This suggests that the ascending aortic diameter is a poor predictor of dissection in most patients. Ascending aortic diameter expands due to acute dissection. Post-dissection aortic diameters probably overestimate pre-dissection diameters. Following ascending dissection, diameter expansion is not limited to aorta ascendens. In this sample, estimated pre-dissection ascending aortic diameters were below 60 mm in 91% of patients and below 50 mm in 85%.
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Affiliation(s)
- Qais W Saleh
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark
| | - Axel C P Diederichsen
- Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark.,Department of Cardiology, Odense University Hospital, Denmark
| | - Jes S Lindholt
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark
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Kring C, Rasmussen LM, Lindholt JS, Diederichsen ACP, Vinholt PJ. Platelet aggregation is not altered among men with diabetes mellitus. Acta Diabetol 2020; 57:389-399. [PMID: 31679079 DOI: 10.1007/s00592-019-01438-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/18/2019] [Indexed: 12/22/2022]
Abstract
AIMS Platelets are pivotal in arterial thrombosis, and platelet hyperresponsiveness may contribute to the increased incidence of cardiovascular events in diabetes mellitus. Consequently, we hypothesized that increased in vitro platelet aggregation responses exist in men with diabetes mellitus. METHODS The Danish Cardiovascular Screening Trial (DANCAVAS) is a community-based cardiovascular screening trial including men aged 65-74 years. Platelet aggregation was tested using 96-well light transmission aggregometry with thrombin receptor-activating peptide (TRAP), adenosine diphosphate, collagen type 1, arachidonic acid and protease-activated receptor-4 in three concentrations. Further, cardiovascular risk factors and coronary artery calcification (CAC), estimated by CT scans and ankle-brachial index, were obtained. RESULTS Included were 720 men aged 65-74 years, 110 with diabetes mellitus. Overall, there was no difference in platelet aggregation among men with versus without diabetes mellitus when adjusting for or excluding platelet inhibitor treatment and men with established cardiovascular disease (CVD). This was true for all agonists, e.g., 10 µM TRAP-induced platelet aggregation of median 69% (IQR 53-75) versus 70% (IQR 60-76) in men with versus without diabetes mellitus. Platelet aggregation did not correlate with HbA1c or CAC. Men with diabetes mellitus displayed higher CAC, median 257 Agatston units (IQR 74-1141) versus median 111 Agatston units (IQR 6-420) in the remaining individuals, p < 0.0001. CONCLUSIONS Among outpatients with diabetes mellitus, but no CVD and no platelet inhibitor treatment, neither are platelets hyperresponsive in diabetes mellitus, nor is platelet aggregation associated with glycemic status or with the degree of coronary atherosclerosis. TRIAL REGISTRATION ISRCTN12157806.
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Affiliation(s)
- Christian Kring
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark.
| | - Lars M Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - Jes S Lindholt
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Axel C P Diederichsen
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Pernille J Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
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10
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Schmidt SE, Winther S, Larsen BS, Groenhoej MH, Nissen L, Westra J, Frost L, Holm NR, Mickley H, Steffensen FH, Lambrechtsen J, Nørskov MS, Struijk JJ, Diederichsen ACP, Boettcher M. Coronary artery disease risk reclassification by a new acoustic-based score. Int J Cardiovasc Imaging 2019; 35:2019-2028. [PMID: 31273633 PMCID: PMC6805823 DOI: 10.1007/s10554-019-01662-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/27/2019] [Indexed: 01/08/2023]
Abstract
To determine the potential of a non-invasive acoustic device (CADScor®System) to reclassify patients with intermediate pre-test probability (PTP) and clinically suspected stable coronary artery disease (CAD) into a low probability group thereby ruling out significant CAD. Audio recordings and clinical data from three studies were collected in a single database. In all studies, patients with a coronary CT angiography indicating CAD were referred to coronary angiography. Audio recordings of heart sounds were processed to construct a CAD-score. PTP was calculated using the updated Diamond-Forrester score and patients were classified according to the current ESC guidelines for stable CAD: low < 15%, intermediate 15–85% and high > 85% PTP. Intermediate PTP patients were re-classified to low probability if the CAD-score was ≤ 20. Of 2245 patients, 212 (9.4%) had significant CAD confirmed by coronary angiography ( ≥ 50% diameter stenosis). The average CAD-score was higher in patients with significant CAD (38.4 ± 13.9) compared to the remaining patients (25.1 ± 13.8; p < 0.001). The reclassification increased the proportion of low PTP patients from 13.6% to 41.8%, reducing the proportion of intermediate PTP patients from 83.4% to 55.2%. Before reclassification 7 (3.1%) low PTP patients had CAD, whereas post-reclassification this number increased to 28 (4.0%) (p = 0.52). The net reclassification index was 0.209. Utilization of a low-cost acoustic device in patients with intermediate PTP could potentially reduce the number of patients referred for further testing, without a significant increase in the false negative rate, and thus improve the cost-effectiveness for patients with suspected stable CAD.
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Affiliation(s)
- S E Schmidt
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark.
| | - S Winther
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
| | - B S Larsen
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark
- Acarix, Lyngby, Denmark
| | - M H Groenhoej
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - L Nissen
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
| | - J Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - N R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - H Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
| | | | - J J Struijk
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark
| | | | - M Boettcher
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
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11
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Haase R, Schlattmann P, Gueret P, Andreini D, Pontone G, Alkadhi H, Hausleiter J, Garcia MJ, Leschka S, Meijboom WB, Zimmermann E, Gerber B, Schoepf UJ, Shabestari AA, Nørgaard BL, Meijs MFL, Sato A, Ovrehus KA, Diederichsen ACP, Jenkins SMM, Knuuti J, Hamdan A, Halvorsen BA, Mendoza-Rodriguez V, Rochitte CE, Rixe J, Wan YL, Langer C, Bettencourt N, Martuscelli E, Ghostine S, Buechel RR, Nikolaou K, Mickley H, Yang L, Zhang Z, Chen MY, Halon DA, Rief M, Sun K, Hirt-Moch B, Niinuma H, Marcus RP, Muraglia S, Jakamy R, Chow BJ, Kaufmann PA, Tardif JC, Nomura C, Kofoed KF, Laissy JP, Arbab-Zadeh A, Kitagawa K, Laham R, Jinzaki M, Hoe J, Rybicki FJ, Scholte A, Paul N, Tan SY, Yoshioka K, Röhle R, Schuetz GM, Schueler S, Coenen MH, Wieske V, Achenbach S, Budoff MJ, Laule M, Newby DE, Dewey M. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. BMJ 2019; 365:l1945. [PMID: 31189617 PMCID: PMC6561308 DOI: 10.1136/bmj.l1945] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42012002780.
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Affiliation(s)
- Robert Haase
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Pascal Gueret
- Department of Cardiology, Henri Mondor Hospital, University Paris Est Créteil, Créteil, France
| | - Daniele Andreini
- Department of Cardiology and Radiology, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | | | - Hatem Alkadhi
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, NY, USA
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Willem B Meijboom
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernhard Gerber
- Department of Cardiology, Clinique Universitaire St Luc, Institut de Recherche Clinique et Expérimentale, Brussels, Belgium
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus Universtity Hostipal, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Axel C P Diederichsen
- Department of Cardiology, Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK
| | - Shona M M Jenkins
- Department of Cardiology, Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK
| | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | - Ashraf Hamdan
- Department of Cardiovascular Imaging, Department of Cardiology, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Johannes Rixe
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Yung Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Christoph Langer
- Heart and Diabetes Center NRW in Bad Oeynhausen, University Clinic of the Ruhr-University Bochum, Bochum, Germany
| | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Said Ghostine
- Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lin Yang
- Department of Radiology, Beijing Anzhen Hospital, Beijing, China
| | - Zhaqoi Zhang
- Department of Radiology, Beijing Anzhen Hospital, Beijing, China
| | - Marcus Y Chen
- National Heart and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - David A Halon
- Cardiovascular Clinical Research Unit, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Matthias Rief
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Inner Mongolia Province, China
| | - Beatrice Hirt-Moch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Roy P Marcus
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Réda Jakamy
- Department of Cardiology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Benjamin J Chow
- University of Ottawa, Heart Institute, Ottawa, Ontario, Canada
| | - Philipp A Kaufmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Klaus F Kofoed
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jean-Pierre Laissy
- Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA
| | | | - Roger Laham
- BIDMC/Harvard Medical School, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | | | - John Hoe
- Department of Radiology, Mount Elizabeth Hospital, Singapore
| | - Frank J Rybicki
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Arthur Scholte
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Narinder Paul
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Swee Y Tan
- National Heart Centre, Singapore, Singapore
| | | | - Robert Röhle
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Georg M Schuetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Schueler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maria H Coenen
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Michael Laule
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - David E Newby
- British Heart Foundation, University of Edinburgh, Edinburgh, UK
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Ramanathan R, Dey D, Nørgaard BL, Goeller M, Bjerrum IS, Antulov R, Diederichsen ACP, Sidelmann JJ, Gram JB, Sand NPR. Carotid plaque composition by CT angiography in asymptomatic subjects: a head-to-head comparison to ultrasound. Eur Radiol 2019; 29:5920-5931. [PMID: 30915562 DOI: 10.1007/s00330-019-06086-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/27/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe carotid plaque composition by computed tomography angiography (CTA) in asymptomatic subjects and to compare this to carotid plaque assessment by ultrasound, coronary plaques by coronary CTA, and inflammatory biomarkers in plasma. METHODS Middle-aged asymptomatic men, n = 43, without known cardiovascular disease and diabetes were included. Plaques in coronary and carotid arteries were evaluated using CTA. Total plaque volumes and plaque composition were assessed by a validated plaque analysis software. The 60% centile cut point was used to divide the population into low or high carotid total plaque volumes. The occurrence of carotid plaques and intima-media thickness (IMT) was estimated by ultrasound. RESULTS Carotid plaque by ultrasound was undiagnosed in 13 of 28 participants (46%) compared to CTA. Participants having carotid plaques by ultrasound had significantly higher absolute volumes of all CTA-defined carotid plaque subtypes and a higher fraction of calcified plaque. A high carotid total plaque volume was independently associated with age (adjusted odds ratio (OR) 1.41 [95% confidence interval (CI) 1.14-1.74], p = 0.001), IMT (adjusted OR 2.26 [95% CI 1.10-4.65], p = 0.03), and D-dimer (adjusted OR 8.86 [95% CI 1.26-62.37], p = 0.03). All coronary plaque features were significantly higher in participants with a high carotid total plaque volume. CONCLUSION The occurrence of carotid plaques in asymptomatic individuals is underestimated by ultrasound compared to plaque assessment by CTA. Carotid plaque composition by CTA is different in individuals with and without carotid plaques by ultrasound. KEY POINTS • The occurrence of carotid plaques by ultrasound was underestimated in 46% of participants who had plaques by carotid CTA. • Participants with carotid plaques by ultrasound had higher volumes of all plaque subtypes and a higher calcified plaque component as determined by carotid CTA compared to participants without carotid plaques by ultrasound. • A high carotid total plaque volume was independently associated with age, intima-media thickness, and D-dimer.
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Affiliation(s)
- Ramshanker Ramanathan
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark.
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, 90048, USA
| | - Bjarne L Nørgaard
- Department of Cardiology, Skejby University Hospital, Aarhus, Denmark
| | - Markus Goeller
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, 90048, USA
| | - Ida S Bjerrum
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ronald Antulov
- Department of Radiology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | | | - Johannes J Sidelmann
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jørgen B Gram
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Niels Peter R Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Khurrami L, Sanddal Lindholt J, Hoigaard Fredgart M, Hald Steffensen F, Frost L, Lambrechtsen J, Busk M, Urbonaviciene G, Egstrup K, Moeller J, Diederichsen ACP. P6055Aortic valve calcification in a general population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Khurrami
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J Sanddal Lindholt
- Odense University Hospital, Department of Cardiothoracic and Vascular Surgery, Odense, Denmark
| | | | | | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J Lambrechtsen
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - M Busk
- Lillebaelt Hospital, Department of Cardiology, Vejle, Denmark
| | - G Urbonaviciene
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - K Egstrup
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - J Moeller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
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14
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Fredgart MH, Carter Storch R, Moeller JE, Oevrehus KA, Pecini R, Dahl JS, Gerke O, Alturkmany RA, Brandes B, Lindholt JS, Diederichsen ACP. P6482Measurement of left atrial size by non-contrast computed tomography, 2D and 3D transthoracic echocardiography compared to cardiac magnetic resonance imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M H Fredgart
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - R Carter Storch
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - K A Oevrehus
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - R Pecini
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J S Dahl
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - O Gerke
- Odense University Hospital, Department of Nuclear Medicine, Odense, Denmark
| | - R A Alturkmany
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - B Brandes
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J S Lindholt
- Odense University Hospital, Department of Cardiothoracic and Vascular Surgery, Odense, Denmark
| | - A C P Diederichsen
- Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
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Fredgart MH, Lindholt JS, Gerke O, Steffensen FH, Frost L, Lambrechtsen J, Busk M, Urbonaviciene G, Egstrup K, Brandes A, Moeller JE, Diederichsen ACP. P4447Association of left atrial size by non-contrast computed tomography with cardiovascular risk factors - the danish cardiovascular screening trial (DANCAVAS). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M H Fredgart
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J S Lindholt
- Odense University Hospital, Department of Cardiothoracic and Vascular Surgery, Odense, Denmark
| | - O Gerke
- Odense University Hospital, Department of Nuclear Medicine, Odense, Denmark
| | - F H Steffensen
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J Lambrechtsen
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - M Busk
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - G Urbonaviciene
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - K Egstrup
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - A Brandes
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - A C P Diederichsen
- Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
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Diederichsen ACP, Rasmussen LM, Sogaard R, Lambrechtsen J, Steffensen FH, Frost L, Busk M, Egstrup K, Urbonaviciene G, Mickley H, Hallas J, Olsen MH, Lindholt JS. P1531Baseline findings of the population-based, randomized danish cardiovascular screening trial (DANCAVAS). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - L M Rasmussen
- Odense University Hospital, Department of Clinical Biochemistry and Pharmacology, Odense, Denmark
| | - R Sogaard
- Aarhus University, Department of Public Health, Aarhus, Denmark
| | - J Lambrechtsen
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - F H Steffensen
- Lillebaelt Hospital, Department of Cardiology, Vejle, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - M Busk
- Lillebaelt Hospital, Department of Cardiology, Vejle, Denmark
| | - K Egstrup
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - G Urbonaviciene
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - H Mickley
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J Hallas
- University of Southern Denmark, Institute of Pharmacology, Odense, Denmark
| | - M H Olsen
- Holbaek Hospital, Department of Cardiology, Holbaek, Denmark
| | - J S Lindholt
- Odense University Hospital, Department of Cardiothoracic and Vascular Surgery, Odense, Denmark
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Kay SD, Carlsen AL, Voss A, Burton M, Diederichsen ACP, Poulsen MK, Heegaard NHH. Associations of circulating cell-free microRNA with vasculopathy and vascular events in systemic lupus erythematosus patients. Scand J Rheumatol 2018; 48:32-41. [DOI: 10.1080/03009742.2018.1450892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- SD Kay
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - AL Carlsen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - A Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - M Burton
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit and Human Genetics, University of Southern Denmark, Odense, Denmark
| | - ACP Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - MK Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - NHH Heegaard
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Lilleker JB, Diederichsen ACP, Jacobsen S, Guy M, Roberts ME, Sergeant JC, Cooper RG, Diederichsen LP, Chinoy H. Using serum troponins to screen for cardiac involvement and assess disease activity in the idiopathic inflammatory myopathies. Rheumatology (Oxford) 2018; 57:1041-1046. [PMID: 29538753 PMCID: PMC5965080 DOI: 10.1093/rheumatology/key031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/25/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives Limitations in the methods available for identifying cardiac involvement and accurately quantifying disease activity in the idiopathic inflammatory myopathies (IIMs) may contribute to poor outcomes. We investigated the utility of different serum muscle damage markers [total creatine kinase (CK), cardiac troponin T (cTnT) and cardiac troponin I (cTnI)] to address these issues. Methods We assessed disease activity and cardiac involvement using the International Myositis Assessment and Clinical Studies Group core set measures in 123 participants with confirmed adult-onset IIM from the UK and Denmark. Total CK, cTnT and cTnI were measured. Associations were assessed using logistic regression and Spearman's ranked correlation. Results Cardiac involvement (n = 18) was associated with higher cTnI levels, independent of overall disease activity [adjusted odds ratio 1.03 (95% CI 1.01, 1.05); P = 0.002]. An abnormal cTnI had the highest specificity and positive predictive value for cardiac involvement (95% and 62%, respectively). In those with a normal CK but elevated cTnT or cTnI, an association with increased disease activity scores was observed. Serum cTnT correlated with the physician (ρ = 0.39) and patient-assessed (ρ = 0.28) global visual analogue scales and HAQ (ρ = 0.41) more strongly than CK or cTnI levels. cTnT was the only marker to correlate with manual muscle testing scores (ρ = -0.24). Conclusion Serum cTnI testing may have a role in screening for cardiac involvement in IIMs. Abnormal levels of serum cTnT and cTnI are associated with increased disease activity, including in those with a normal CK.
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Affiliation(s)
- James B Lilleker
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark Guy
- Department of Biochemistry, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Mark E Roberts
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Jamie C Sergeant
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Robert G Cooper
- MRC-ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | | | - Hector Chinoy
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Lambrecht S, Sarkisian L, Saaby L, Poulsen TS, Gerke O, Hosbond S, Diederichsen ACP, Thygesen K, Mickley H. Different Causes of Death in Patients with Myocardial Infarction Type 1, Type 2, and Myocardial Injury. Am J Med 2018; 131:548-554. [PMID: 29274756 DOI: 10.1016/j.amjmed.2017.11.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Data outlining the mortality and the causes of death in patients with type 1 myocardial infarction, type 2 myocardial infarction, and those with myocardial injury are limited. METHODS During a 1-year period from January 2010 to January 2011, all hospitalized patients who had cardiac troponin I measured on clinical indication were prospectively studied. Patients with at least one cardiac troponin I value >30 ng/L underwent case ascertainment and individual evaluation by an experienced adjudication committee. Patients were classified as having type 1 myocardial infarction, type 2 myocardial infarction, or myocardial injury according to the criteria of the universal definition of myocardial infarction. Follow-up was ensured until December 31, 2014. Data on mortality and causes of death were obtained from the Danish Civil Registration System and the Danish Register of Causes of Death. RESULTS Overall, 3762 consecutive patients were followed for a mean of 3.2 years (interquartile range 1.3-3.6 years). All-cause mortality differed significantly among categories: Type 1 myocardial infarction 31.7%, type 2 myocardial infarction 62.2%, myocardial injury 58.7%, and 22.2% in patients with nonelevated troponin values (log-rank test; P < .0001). In patients with type 1 myocardial infarction, 61.3% died from cardiovascular causes, vs 42.6% in patients with type 2 myocardial infarction (P = .015) and 41.2% in those with myocardial injury (P < .0001). The overall mortality and the causes of death did not differ substantially between patients with type 2 myocardial infarction and those with myocardial injury. CONCLUSIONS Patients with type 2 myocardial infarction and myocardial injury exhibit a significantly higher long-term mortality compared with patients with type 1 myocardial infarction . However, most patients with type 1 myocardial infarction die from cardiovascular causes in contrast to patients with type 2 myocardial infarction and myocardial injury, in whom noncardiovascular causes of death predominate.
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Affiliation(s)
- Sascha Lambrecht
- Department of Cardiology, Odense University Hospital (OUH), Odense, Denmark
| | - Laura Sarkisian
- Department of Cardiology, Odense University Hospital (OUH), Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital (OUH), Odense, Denmark
| | - Tina S Poulsen
- Department of Cardiology, Odense University Hospital (OUH), Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, OUH, Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Hosbond
- Department of Cardiology, Odense University Hospital (OUH), Odense, Denmark
| | | | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital (OUH), Odense, Denmark.
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20
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Pedersen KB, Madsen C, Sandgaard NCF, Diederichsen ACP, Bak S, Brandes A. Subclinical atrial fibrillation in patients with recent transient ischemic attack. J Cardiovasc Electrophysiol 2018; 29:707-714. [PMID: 29478291 DOI: 10.1111/jce.13470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/06/2018] [Accepted: 01/26/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a major risk factor of stroke, but the association between AF and transient ischemic attack (TIA) is less clear. Despite this, patients with TIA are included in stroke trials. AIMS To determine the 1-year incidence of AF in TIA patients using an insertable cardiac monitor (ICM); second, to determine factors associated with incident AF in these patients. METHODS Prospective cohort study of patients with TIA with normal standard electrocardiogram (ECG) and 72-hour Holter monitoring (HM). Exclusion criteria were as follows: age < 18 or > 81 years; prior AF/stroke; ongoing oral anticoagulation therapy or contraindication for it; significant carotid artery stenosis; uncertain TIA diagnosis. Eligible patients received an ICM and were followed for 12 months. RESULTS From November 2013 to October 2015, 809 patients were diagnosed with TIA. In total, 235 patients were eligible. Nine (3.8%) of these had AF on standard ECG or HM. Of the remaining patients, 121 refused ICM implantation. In total, 105 patients (median age 65.4 years [range 27.1-80.8], 46% males) received an ICM, which revealed AF in 7 (6.7%). Factors associated with new-onset AF were a history of recurrent TIA (odds ratio [OR] 11.5, 95% confidence interval [CI] 2.1-63.6) and heart failure (OR 12.7, 95% CI 1.71-96.83). CONCLUSIONS The 1-year incidence of AF in TIA patients with normal ECG and HM was 6.7% using an ICM. Factors associated with development of AF were recurrent TIA and heart failure.
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Affiliation(s)
| | - Charlotte Madsen
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | | | | | - Søren Bak
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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21
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Larsen TR, Gerke O, Diederichsen ACP, Lambrechtsen J, Steffensen FH, Sand NP, Antonsen S, Mickley H. Lack of association between cystatin C and different coronary atherosclerotic manifestations. Scand J Clin Lab Invest 2017; 77:574-581. [PMID: 28749732 DOI: 10.1080/00365513.2017.1355980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cystatin C (CysC) is known to be related to cardiovascular disease (CVD), including the presence and severity of coronary artery disease (CAD) and future clinical events. In this study, the association between CysC levels and (1) coronary artery calcification (CAC) in asymptomatic individuals from the general population as well as (2) different subgroups of patients with suspected or definite acute myocardial infarction (MI) was investigated. CysC levels were measured in serum from asymptomatic individuals as part of a screening study for CAC using non-contrast cardiac CT scan (N = 1039) as well as in subgroups of hospitalized patients with a suspected MI (N = 769). CysC was not associated with CAC in asymptomatic individuals after adjusting for relevant risk factors. No difference in CysC levels was observed between patients with type 1 MI (1.07 mg/L) and patients with normal troponin (with or without prior CAD: 1.14 and 1.01 mg/L, respectively). However, patients with type 2 MI and patient subgroups with elevated troponin but without MI had significantly higher CysC levels (1.24, 1.23 and 1.31 mg/L), even after adjusting for other risk factors. CysC was not associated with CAC in middle-aged asymptomatic individuals from the general population. Furthermore, CysC levels were found to be significantly lower in patients with type 1 MI compared to patients with type 2 MI and patients with elevated troponins but without MI. Thus, in two independent and clinically different populations, no association between CysC and coronary atherosclerotic manifestations could be demonstrated.
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Affiliation(s)
- Trine R Larsen
- a Department of Clinical Biochemistry , Svendborg Hospital , Svendborg , Denmark
| | - Oke Gerke
- b Department of Nuclear Medicine , Odense University Hospital , Odense C , Denmark.,c Centre of Health Economics Research , University of Southern Denmark , Odense M , Denmark
| | | | - Jess Lambrechtsen
- e Department of Cardiology , Svendborg Hospital , Svendborg , Denmark
| | | | - Niels Peter Sand
- g Department of Cardiology , Hospital of Southwest Denmark , Esbjerg , Denmark.,h Institute of Regional Health Research, University of Southern Denmark , Odense M , Denmark
| | - Steen Antonsen
- a Department of Clinical Biochemistry , Svendborg Hospital , Svendborg , Denmark
| | - Hans Mickley
- d Department of Cardiology , Odense University Hospital , Odense C , Denmark
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Jangaard N, Sarkisian L, Saaby L, Mikkelsen S, Lassen AM, Marcussen N, Thomsen JL, Diederichsen ACP, Thygesen K, Mickley H. Incidence, Frequency, and Clinical Characteristics of Type 3 Myocardial Infarction in Clinical Practice. Am J Med 2017; 130:862.e9-862.e14. [PMID: 28159605 DOI: 10.1016/j.amjmed.2016.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cardiac death in a patient with symptoms and electrocardiographic changes indicative of myocardial ischemia but without available measurements of cardiac biomarkers is designated a type 3 myocardial infarction. We wanted to investigate the incidence, the frequency, and the characteristics of patients diagnosed as type 3 myocardial infarction. METHODS The occurrence of deaths in a well-defined geographic region was retrieved from the Danish Civil Registration System during a 1-year period from 2010 to 2011. Complementary data concerning causes of deaths were obtained from the Danish Register of Causes of Death, and ambulance and hospital patient files. Adjudication of the diagnosis was done by 2 local experts and one external senior cardiologist. RESULTS A total of 2766 of the 246,723 adult residents in the region had died. A type 3 myocardial infarction was diagnosed in 18 individuals, corresponding to an annual incidence of 7.3/100,000 person-years. During the same 1-year period, 488 patients had other types of myocardial infarction implying a 3.6% frequency of type 3 myocardial infarction (18 of 506) among all myocardial infarctions. CONCLUSION Type 3 myocardial infarction is a rare observation in clinical practice with an annual incidence below 10/100,000 person-years and a frequency of 3%-4% among all types of myocardial infarction. If autopsy data are included, the number of type 3 myocardial infarctions will increase.
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Affiliation(s)
| | - Laura Sarkisian
- Department of Cardiology, Odense University Hospital, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Denmark
| | - Søren Mikkelsen
- Mobile Emergency Care Unit, Department of Anesthesiology and Intensive Care, Odense University Hospital, Denmark
| | - Anne Marie Lassen
- Department of Emergency Medicine, Odense University Hospital, Denmark
| | | | - Jørgen L Thomsen
- Institute of Forensic Medicine, Odense University Hospital, Denmark
| | | | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Denmark.
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Kvist TV, Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Olsen MH, Mickley H, Hallas J, Urbonaviciene G, Busk M, Egstrup K, Diederichsen ACP. The DanCavas Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65-74 Years. Eur J Vasc Endovasc Surg 2016; 53:123-131. [PMID: 27890524 DOI: 10.1016/j.ejvs.2016.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/BACKGROUND This pilot study of a large population based randomised screening trial investigated feasibility, acceptability, and relevance (prevalence of clinical and subclinical cardiovascular disease [CVD] and proportion receiving insufficient prevention) of a multifaceted screening for CVD. METHODS In total, 2060 randomly selected Danish men and women aged 65-74 years were offered (i) low dose non-contrast computed tomography to detect coronary artery calcification (CAC) and aortic/iliac aneurysms; (ii) detection of atrial fibrillation (AF); (iii) brachial and ankle blood pressure measurements; and (iv) blood levels of cholesterol and hemoglobin A1c. Web based self booking and data management was used to reduce the administrative burden. RESULTS Attendance rates were 64.9% (n = 678) and 63.0% (n = 640) for men and women, respectively. In total, 39.7% received a recommendation for medical preventive actions. Prevalence of aneurysms was 12.4% (95% confidence interval [CI] 9.9-14.9) in men and 1.1% (95% CI 0.3-1.9) in women, respectively (p < .001). A CAC score > 400 was found in 37.8% of men and 11.3% of women (p < .001), along with a significant increase in median CAC score with age (p = .03). Peripheral arterial disease was more prevalent in men (18.8%, 95% CI 15.8-21.8) than in women (11.2%, 95% CI 8.7-13.6). No significant differences between the sexes were found with regard to newly discovered AF (men 1.3%, women 0.5%), potential hypertension (men 9.7%, women 11.5%), hypercholesterolemia (men 0.9%, women 1.1%) or diabetes mellitus (men 2.1%, women 1.3%). CONCLUSION Owing to the higher prevalence of severe conditions, such as aneurysms and CAC ≥ 400, screening for CVD seemed more prudent in men than women. The attendance rates were acceptable compared with other screening programs and the logistical structure of the screening program proved successful.
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Affiliation(s)
- T V Kvist
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark.
| | - J S Lindholt
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M H Olsen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - H Mickley
- Department of Cardiology, Odense University Hospital, Odense C, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense C, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - K Egstrup
- Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark
| | - A C P Diederichsen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense C, Denmark
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Sarkisian L, Saaby L, Poulsen TS, Gerke O, Hosbond S, Jangaard N, Diederichsen ACP, Thygesen K, Mickley H. Prognostic Impact of Myocardial Injury Related to Various Cardiac and Noncardiac Conditions. Am J Med 2016; 129:506-514.e1. [PMID: 26763756 DOI: 10.1016/j.amjmed.2015.12.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Elevated cardiac troponins in clinical conditions other than myocardial infarction are well known. For such occurrences, the term "myocardial injury" has been proposed. The long-term outcome in patients with myocardial injury related to various cardiac and noncardiac clinical disorders is unknown. METHODS During January 2010 to January 2011, we prospectively studied hospitalized patients who had cardiac troponin I measured on clinical indication. Patients with cardiac troponin I values >30 ng/L and no evidence of myocardial ischemia were diagnosed as having myocardial injury. Patients were classified into 5 categories of plausible related conditions: cardiac ischemic, cardiac nonischemic, noncardiac, multifactorial, or indeterminate. Follow-up was a minimum of 3 years, with all-cause mortality as the single end-point. RESULTS A total of 3762 patients were considered, of whom 1089 (29%) had myocardial injury. The most common associated conditions were noncardiac (n = 346) or multifactorial (n = 359). Cardiac ischemic (n = 183) and cardiac nonischemic (n = 134) conditions occurred less frequently. After a median of 3.2 years, 645 patients (59%) had died. A multivariate Cox regression analysis showed no difference in mortality between patients with cardiac ischemic and cardiac nonischemic conditions (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.50-1.13; P = .2). Patients with noncardiac or multifactorial disorders, however, had significantly higher mortality than those with associated cardiac ischemic conditions (HR 1.39; 95% CI, 1.06-1.80; P = .02, and HR 1.94; 95% CI, 1.50-2.51; P <.001), respectively. CONCLUSIONS In patients with myocardial injury, the most common associated conditions were noncardiac or multifactorial. Of notice, these patients had significantly higher long-term mortality when compared with those with associated cardiac conditions.
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Affiliation(s)
- Laura Sarkisian
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tina S Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Hosbond
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Nikolaj Jangaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Sarkisian L, Saaby L, Poulsen TS, Gerke O, Jangaard N, Hosbond S, Diederichsen ACP, Thygesen K, Mickley H. Clinical Characteristics and Outcomes of Patients with Myocardial Infarction, Myocardial Injury, and Nonelevated Troponins. Am J Med 2016; 129:446.e5-446.e21. [PMID: 26593739 DOI: 10.1016/j.amjmed.2015.11.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cardiac troponins have emerged as the preferred biomarkers for detecting myocardial necrosis and diagnosing myocardial infarction. However, current cardiac troponin assays do not discriminate between ischemic and nonischemic causes of myocardial cell death. Thus, when an increased troponin value is encountered in the absence of obvious myocardial ischemia, a careful search for other clinical conditions is crucial. METHODS In 2010 to 2011, we prospectively studied hospitalized patients who had cardiac troponin I measured on clinical indication. An acute myocardial infarction was diagnosed in cases of a cardiac troponin I increase or decrease pattern with at least 1 value >30 ng/L (99th percentile) together with myocardial ischemia. Myocardial injury was defined as cardiac troponin I values >30 ng/L, but without signs or symptoms indicating overt cardiac ischemia. Patients with peak values ≤30 ng/L were classified as nonelevated cardiac troponin I. Follow-up was at least 3 years with all-cause mortality as the sole clinical end point. RESULTS A total of 3762 patients were included. Of these, 488 (13%) had acute myocardial infarction, 1089 (29%) had myocardial injury, and 2185 (58%) had nonelevated cardiac troponin I values. Patients with myocardial injury frequently presented with dyspnea, were older, and had more comorbidity than patients in the 2 other groups. During a median follow-up of 3.2 years, 1342 patients died. Mortality differed significantly between groups: 39% in those with myocardial infarction, 59% in those with myocardial injury, and 23% in those with nonelevated cardiac troponin I (log-rank test; P < .0001). No significant difference in mortality between patients with type 2 myocardial infarction and patients with myocardial injury was observed (63% and 59%, respectively). CONCLUSIONS Patients with myocardial injury are older and have more comorbidity than those with acute myocardial infarction. Both groups exhibit a poorer prognosis than patients with nonelevated cardiac troponin I values. Of note, a very high long-term mortality is observed in patients with type 2 myocardial infarction and patients with myocardial injury.
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Affiliation(s)
- Laura Sarkisian
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tina S Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, and Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Nikolaj Jangaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Susanne Hosbond
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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D'Souza M, Sarkisian L, Saaby L, Poulsen TS, Gerke O, Larsen TB, Diederichsen ACP, Jangaard N, Diederichsen SZ, Hosbond S, Hove J, Thygesen K, Mickley H. Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays. Am J Med 2015; 128:852-60. [PMID: 25820165 DOI: 10.1016/j.amjmed.2015.01.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 01/24/2015] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been studied prospectively in unselected hospital patients. METHODS During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI, and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System. RESULTS Of 3762 consecutive patients, 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67%, and STEMI in 26%. The NSTEMI patients were older, more frequently women, and had more comorbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI, and 25% of STEMI patients. Age-adjusted log-rank statistics revealed differences in mortality: NSTEMI vs unstable angina pectoris (P = .0091) and NSTEMI vs STEMI (P = .0045). CONCLUSIONS The application of the universal definition together with the use of a contemporary troponin assay seems to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this, NSTEMI patients have a sustained higher mortality than patients with STEMI.
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Affiliation(s)
- Maria D'Souza
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Laura Sarkisian
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tina S Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital and Center of Health Economics Research, Odense, Denmark
| | - Torben B Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Nikolaj Jangaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Susanne Hosbond
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens Hove
- Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Tofterup ML, Beck-Nielsen H, Gerke O, Egstrup K, Sand NPR, Munkholm H, Mickley H, Diederichsen ACP. One-third Of Patients With Type 2 Diabetes Mellitus Do Not Have Coronary Artery Calcification. ACTA ACUST UNITED AC 2015. [DOI: 10.14302/issn.2474-3585.jpmc-14-540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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28
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Diederichsen LP, Diederichsen ACP, Simonsen JA, Junker P, Søndergaard K, Lundberg IE, Tvede N, Gerke O, Christensen AF, Dreyer L, Petersen H, Ejstrup L, Kay SD, Jacobsen S. Traditional Cardiovascular Risk Factors and Coronary Artery Calcification in Adults With Polymyositis and Dermatomyositis: A Danish Multicenter Study. Arthritis Care Res (Hoboken) 2015; 67:848-54. [DOI: 10.1002/acr.22520] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/29/2014] [Accepted: 11/11/2014] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | | | | | | | - Niels Tvede
- Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Oke Gerke
- Odense University Hospital, and University of Southern Denmark; Odense Denmark
| | | | - Lene Dreyer
- Gentofte University Hospital; Hellerup Denmark
| | | | | | | | - Søren Jacobsen
- Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
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Bar-Shalom D, Poulsen MK, Rasmussen LM, Diederichsen ACP, Sand NPR, Henriksen JE, Nybo M. Plasma copeptin as marker of cardiovascular disease in asymptomatic type 2 diabetes patients. Diab Vasc Dis Res 2014; 11:448-50. [PMID: 25097143 DOI: 10.1177/1479164114544464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Recently, copeptin was found associated with cardiovascular disease (CVD) and all-cause mortality in type 2 diabetes mellitus (T2DM) patients treated in primary care. This study aimed to evaluate whether plasma copeptin correlated to CVD in asymptomatic T2DM patients intensively investigated for sub-clinical CVD. A total of 302 T2DM patients referred to the Diabetes Clinic at Odense University Hospital, Denmark, entered the study. None of the patients had known or suspected CVD. As a control group, 30 healthy adults were recruited from the DanRisk study - a random sample of middle-aged Danes. A variety of clinical investigations were performed, including blood pressure measurements, carotid intima media thickness evaluation and myocardial perfusion scintigraphy. Blood sample analyses included copeptin measurements. Median plasma copeptin concentrations were similar in the T2DM group and the control group. However, men had significantly higher copeptin concentrations than women in the T2DM group (p < 0.001), and also, T2DM men had significantly higher copeptin concentrations than men without T2DM (p = 0.038). Copeptin correlated significantly with a number of variables, but the strongest correlation was with creatinine (R = 0.432, p < 0.001), and in multiple regression analysis, only this correlation remained significant. When association with clinical scores were investigated, plasma copeptin remained significantly associated with peripheral arterial disease (PAD) (p = 0.01). We found correlations between creatinine, copeptin levels and PAD in T2DM patients, and if confirmed, plasma copeptin combined with plasma creatinine could be a candidate for PAD screening in T2DM patients.
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Affiliation(s)
- Dana Bar-Shalom
- Department of Clinical Biochemistry and Pharmacology, Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark
| | - Mikael K Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars M Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark
| | | | - Niels P R Sand
- Department of Cardiology, Sydvestjysk Hospital, Esbjerg, Denmark
| | - Jan E Henriksen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark
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30
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Nielsen ML, Pareek M, Gerke O, Diederichsen SZ, Greve SV, Blicher MK, Sand NPR, Mickley H, Diederichsen ACP, Olsen MH. Uncontrolled hypertension is associated with coronary artery calcification and electrocardiographic left ventricular hypertrophy: a case-control study. J Hum Hypertens 2014; 29:303-8. [PMID: 25273860 DOI: 10.1038/jhh.2014.88] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/24/2014] [Accepted: 08/18/2014] [Indexed: 11/09/2022]
Abstract
We conducted a 1:2 matched case-control study in order to evaluate whether the prevalence of coronary artery calcium (CAC) and electrocardiographic left ventricular hypertrophy (LVH) or strain was higher in patients with uncontrolled hypertension than in subjects from the general population, and evaluate the association between CAC and LVH in patients with uncontrolled hypertension. Cases were patients with uncontrolled hypertension, whereas the controls were random individuals from the general population without cardiovascular disease. CAC score was assessed using a non-contrast computed tomographic scan. LVH was evaluated using the Sokolow-Lyon voltage combination and Cornell voltage-duration product, respectively. Associations between CAC, LVH and traditional cardiovascular risk factors were tested by means of ordinal, conditional and classic binary logistic regression models. We found that uncontrolled hypertension was independently associated with both an ordinal CAC score category (odds ratio (OR) 3.9 (95% CI, 1.6-9.1), P = 0.002), the presence of CAC score>99 (OR 4.5 (95% CI, 1.4-14.7), P = 0.01) and electrocardiographic LVH (OR 10.1 (95% CI, 3.4-30.2), P < 0.001) on both univariate and multivariable analyses. There was, however, no correlation between CAC and LVH. The lack of an association between CAC and LVH suggests that they are markers of different complications of hypertension and may have independent predictive values. Patients with both CAC and LVH may be at higher risk than those in whom only one of these markers is present.
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Affiliation(s)
- M L Nielsen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | - M Pareek
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | - O Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense and Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - S Z Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - S V Greve
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | - M K Blicher
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | - N P R Sand
- Department of Cardiology, Sydvestjysk Hospital, Esbjerg, Denmark
| | - H Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - M H Olsen
- 1] Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark [2] Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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31
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Pedersen C, Thomsen CF, Hosbond SE, Thomassen A, Mickley H, Diederichsen ACP. Coronary computed tomography angiography - tolerability of β-blockers and contrast media, and temporal changes in radiation dose. SCAND CARDIOVASC J 2014; 48:271-7. [PMID: 25100617 DOI: 10.3109/14017431.2014.951958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the risk in administering β-blockers, contrast-induced nephropathy (CIN) and the trend in X-ray use, during coronary computed tomography angiography (CCTA). METHODS A total of 416 patients were referred for elective CCTA. To achieve a resting heart rate below 60 beats per minute, oral and/or intravenous β-blockers were administered. Using questionnaires, information on the adverse effects of β-blockers was collected from the patients. The levels of s-creatinine and estimated GFR (eGFR) were measured before and after contrast enhanced CCTA. Radiation exposure was compared with the exposure 3 years earlier. RESULTS There was no significant difference in the symptoms (dizziness, lipothymia and palpitations) between patients with and patients without β-blocker pretreatment. Compared to baseline values, the decrease in s-creatinine was not significant (75.2 vs. 74.6 μmol/L, p = 0.09), while the increase in eGFR was not significant (78 vs. 79 mL/min, p = 0.17). Also, subgroups of patients with hypertension, hypercholesterolemia, diabetes or pre-existing slight impairment in renal function did not develop CIN. The mean radiation exposure decreased from 17.5 to 6.7 mSv, p < 0.0001. CONCLUSIONS In terms of the side effects of β-blockers and contrast media, there were no short term complications to CCTA. Furthermore, the radiation dose has been dramatically diminished over the last three years.
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Affiliation(s)
- Charlotte Pedersen
- Department of Cardiology, Odense University Hospital , Odense C , Denmark
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32
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Ramanathan R, Gram J, Sidelmann JJ, Bjerrum IS, Diederichsen ACP, Jespersen J, Sand NPR. P228Association of vessel wall changes with cardiovascular risk markers in healthy individuals. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Blomberg BA, Thomassen A, Takx RAP, Hildebrandt MG, Simonsen JA, Buch-Olsen KM, Diederichsen ACP, Mickley H, Alavi A, Høilund-Carlsen PF. Delayed ¹⁸F-fluorodeoxyglucose PET/CT imaging improves quantitation of atherosclerotic plaque inflammation: results from the CAMONA study. J Nucl Cardiol 2014; 21:588-97. [PMID: 24633502 DOI: 10.1007/s12350-014-9884-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to determine if delayed (18)F-fluorodeoxyglucose ((18)FDG) PET/CT imaging improves quantitation of atherosclerotic plaque inflammation. Blood-pool activity can disturb the arterial (18)FDG signal. With time, blood-pool activity declines. Therefore, delayed imaging can potentially improve quantitation of vascular inflammation. METHODS AND RESULTS 40 subjects were prospectively assessed by dual-time-point PET/CT imaging at approximately 90 and 180 minutes after (18)FDG administration. For both time-points, global uptake of (18)FDG was determined in the carotid arteries and thoracic aorta by calculating the blood-pool corrected maximum standardized uptake value (cSUVMAX). A target-to-background ratio (TBR) was calculated to determine the contrast resolution at 90 and 180 minutes. Furthermore, we assessed whether the acquisition time-point affected the relation between cSUVMAX and the estimated 10-year risk for fatal cardiovascular disease (SCORE %). A significant increase in carotid cSUVMAX (23%, P < .0001), carotid TBR (20%, P < .0001), aortic cSUVMAX (14%, P < .0001), and aortic TBR (20%, P < .0001) was observed with time. At 90 minutes, cSUVMAX did not relate to SCORE %, whereas at 180 minutes significant positive relations were observed between SCORE % and carotid (τ = 0.25, P = .045) and aortic (τ = 0.33, P = .008) cSUVMAX. CONCLUSIONS Delayed (18)FDG PET/CT imaging at 180 minutes improves quantitation of atherosclerotic plaque inflammation over imaging at 90 minutes. Therefore, the optimal acquisition time-point to assess atherosclerotic plaque inflammation lies beyond the advocated time-point of 90 minutes after (18)FDG administration.
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Affiliation(s)
- Björn A Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark,
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34
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Asmar A, Ozcan C, Diederichsen ACP, Thomassen A, Gill S. Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis. Eur Heart J Cardiovasc Imaging 2014; 15:1013-9. [PMID: 24711514 DOI: 10.1093/ehjci/jeu054] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the clinical importance of 18F-FDG-PET/CT used in the extra cardiac work-up of patients with infective endocarditis (IE). BACKGROUND IE is a serious condition with a significant mortality. Besides the degree of valvular involvement, the prognosis relies crucially on the presence of systemic infectious embolism. METHODS Seventy-two patients (71% males and mean age 63 ± 17 years) with IE were evaluated with 18F-FDG-PET/CT in addition to standard work-up including patient history, physical examination, conventional imaging modalities, and weekly interdisciplinary conferences. When previous unknown lesions detected by 18F-FDG-PET/CT were confirmed by succeeding examinations, they were considered true positive new findings and were further assessed for their clinical importance. Number needed to investigate was calculated as the number of patients who needed to undergo 18F-FDG-PET/CT to find at least one clinical important true positive new finding, not identified by standard work-up prior to 18F-FDG-PET/CT. RESULTS 18F-FDG-PET/CT detected 114 lesions and 64 were true positive, of which 25 were new findings and detected in 17 patients. In 11 patients, the lesions were considered to have a clinical importance; osteomyelitis (n = 7), iliopsoas abscess (n = 1), gastrointestinal lesions (n = 2), and vascular prosthetic graft (n = 1). Number needed to investigate was 7 (11 of 72 patients). CONCLUSIONS 18F-FDG-PET/CT detected lesions of clinical importance in one of seven IE patients and may be a substantial imaging technique for tracing peripheral infectious embolism due to IE. Thus, 18F-FDG-PET/CT may help to guide adequate therapy and thereby improve the prognosis of patients with IE.
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Affiliation(s)
- Ali Asmar
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Cengiz Ozcan
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Axel C P Diederichsen
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Anders Thomassen
- Department of Nuclear Medicine, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Sabine Gill
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
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35
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Blomberg BA, Thomassen A, Takx RAP, Vilstrup MH, Hess S, Nielsen AL, Diederichsen ACP, Mickley H, Alavi A, Høilund-Carlsen PF. Delayed sodium 18F-fluoride PET/CT imaging does not improve quantification of vascular calcification metabolism: results from the CAMONA study. J Nucl Cardiol 2014; 21:293-304. [PMID: 24307262 DOI: 10.1007/s12350-013-9829-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/03/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND This study aimed to determine if delayed sodium (18)F-fluoride (Na(18)F) PET/CT imaging improves quantification of vascular calcification metabolism. Blood-pool activity can disturb the arterial Na(18)F signal. With time, blood-pool activity declines. Therefore, delayed imaging can potentially improve quantification of vascular calcification metabolism. METHODS AND RESULTS Twenty healthy volunteers and 18 patients with chest pain were prospectively assessed by triple time-point PET/CT imaging at approximately 45, 90, and 180 minutes after Na(18)F administration. For each time point, global uptake of Na(18)F was determined in the coronary arteries and thoracic aorta by calculating the blood-pool-corrected maximum standardized uptake value (cSUV(MAX)). A target-to-background ratio (TBR) was calculated to determine the contrast resolution at 45, 90, and 180 minutes. Furthermore, we assessed whether the acquisition time-point affected the relation between cSUV(MAX) and the estimated 10-year risk for fatal cardiovascular disease (SCORE %). Coronary cSUV(MAX) (P = .533) and aortic cSUV(MAX) (P = .654) remained similar with time, whereas the coronary TBR (P < .0001) and aortic TBR (P < .0001) significantly increased with time. Even though the contrast resolution improved with time, positive correlations between SCORE % and coronary cSUV(MAX) (P < .020) and aortic cSUV(MAX) (P < .005) were observed at all investigated time points. CONCLUSIONS Delayed Na(18)F PET/CT imaging does not improve quantification of vascular calcification metabolism. Although contrast resolution improves with time, arterial Na(18)F avidity is invariant to the time between Na(18)F administration and PET/CT acquisition. Therefore, the optimal PET/CT acquisition time-point to quantify vascular calcification metabolism is achieved as early as 45 minutes after Na(18)F administration.
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Affiliation(s)
- Björn A Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark,
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36
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Hosbond SE, Diederichsen ACP, Pedersen L, Rasmussen LM, Munkholm H, Gerke O, Poulsen TS, Mickley H. Lipocalin-type prostaglandin D synthase is not a biomarker of atherosclerotic manifestations. Scand J Clin Lab Invest 2014; 74:219-27. [PMID: 24456422 DOI: 10.3109/00365513.2013.877595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Over the last decades Lipocalin-type prostaglandin D synthase (L-PGDS), Osteoprotegerin (OPG), Osteopontin (OPN) and Pregnancy associated plasma protein A (PAPP-A) have been reported to be associated with coronary artery disease, and L-PGDS has been proposed as a potential new diagnostic tool in the setting of stable coronary artery disease. We set out to investigate if measurement of concentrations of these biomarkers could be used to differentiate between four groups of individuals with different atherosclerotic manifestations. METHODS A total of 120 individuals from four equal gender- and age-matched groups were studied: (i) no previous cardiovascular disease (CVD) and no coronary calcifications [CAC-negative group], (ii) no previous CVD but evidence of severe coronary calcifications [CAC-positive group], (iii) acute coronary syndrome [ACS-group], and (iv) clinical stable patients with CVD, who were referred for cardiovascular surgery [CVD-group]. Concentrations of L-PGDS, OPG, OPN and PAPP-A were analyzed and compared between the four groups. RESULTS We did not find any significant differences in L-PGDS concentrations between the four groups (p = 0.32). OPG concentrations differed significantly (p = 0.003), with the highest concentration observed in ACS patients. Considering OPN (p = 0.12) and PAPP-A (p = 0.53) their concentrations between groups did not differ significantly. CONCLUSION The main message from this study is the observation that L-PGDS based on a single blood test appears to be less valuable than previously proposed in identification of patients with coronary artery disease. However, ACS patients have higher OPG concentrations than patients with different manifestations of stable atherosclerosis. Neither OPN nor PAPP-A concentrations differed between groups.
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Affiliation(s)
- Susanne E Hosbond
- Department of Cardiology, Odense University Hospital , Odense , Denmark
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37
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Wulf-Johansson H, Lock Johansson S, Schlosser A, Trommelholt Holm A, Melholt Rasmussen L, Mickley H, Diederichsen ACP, Munkholm H, Poulsen TS, Tornøe I, Nielsen V, Marcussen N, Vestbo J, Sækmose SG, Holmskov U, Sorensen GL. Localization of microfibrillar-associated protein 4 (MFAP4) in human tissues: clinical evaluation of serum MFAP4 and its association with various cardiovascular conditions. PLoS One 2013; 8:e82243. [PMID: 24349233 PMCID: PMC3862580 DOI: 10.1371/journal.pone.0082243] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/21/2013] [Indexed: 11/28/2022] Open
Abstract
Microfibrillar-associated protein 4 (MFAP4) is located in the extracellular matrix (ECM). We sought to identify tissues with high levels of MFAP4 mRNA and MFAP4 protein expression. Moreover, we aimed to evaluate the significance of MFAP4 as a marker of cardiovascular disease (CVD) and to correlate MFAP4 with other known ECM markers, such as fibulin-1, osteoprotegerin (OPG), and osteopontin (OPN). Quantitative real-time PCR demonstrated that MFAP4 mRNA was more highly expressed in the heart, lung, and intestine than in other elastic tissues. Immunohistochemical studies demonstrated high levels of MFAP4 protein mainly at sites rich in elastic fibers and within blood vessels in all tissues investigated. The AlphaLISA technique was used to determine serum MFAP4 levels in a clinical cohort of 172 patients consisting of 5 matched groups with varying degrees of CVD: 1: patients with ST elevation myocardial infarction (STEMI), 2: patients with non-STEMI, 3: patients destined for vascular surgery because of various atherosclerotic diseases (stable atherosclerotic disease), 4: apparently healthy individuals with documented coronary artery calcification (CAC-positive), and 5: apparently healthy individuals without signs of coronary artery calcification (CAC-negative). Serum MFAP4 levels were significantly lower in patients with stable atherosclerotic disease than CAC-negative individuals (p<0.05). Furthermore, lower serum MFAP4 levels were present in patients with stable atherosclerotic disease compared with STEMI and non-STEMI patients (p<0.05). In patients with stable atherosclerotic disease, positive correlations between MFAP4 and both fibulin-1 (ρ = 0.50; p = 0.0244) and OPG (ρ = 0.62; p = 0.0014) were found. Together, these results indicate that MFAP4 is mainly located in elastic fibers and is highly expressed in blood vessels. The present study suggests that serum MFAP4 varies in groups of patients with different cardiovascular conditions. Further studies are warranted to describe the role of serum MFAP4 as a biomarker of stable atherosclerotic disease.
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Affiliation(s)
- Helle Wulf-Johansson
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Sofie Lock Johansson
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Anders Schlosser
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Anne Trommelholt Holm
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Lars Melholt Rasmussen
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Hans Mickley
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Axel C. P. Diederichsen
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Munkholm
- Department of Cardiology, Lillebælt Hospital Vejle, Vejle, Denmark
| | | | - Ida Tornøe
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Vicki Nielsen
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Niels Marcussen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
| | - Jørgen Vestbo
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Respiratory and Allergy Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Susanne Gjørup Sækmose
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Clinical Immunology, Næstved Hospital, Næstved, Denmark
| | - Uffe Holmskov
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Grith Lykke Sorensen
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Skjøt-Arkil H, Clausen RE, Rasmussen LM, Wang W, Wang Y, Zheng Q, Mickley H, Saaby L, Diederichsen ACP, Lambrechtsen J, Martinez FJ, Hogaboam CM, Han M, Larsen MR, Nawrocki A, Vainer B, Krustrup D, Bjørling-Poulsen M, Karsdal MA, Leeming DJ. Acute Myocardial Infarction and Pulmonary Diseases Result in Two Different Degradation Profiles of Elastin as Quantified by Two Novel ELISAs. PLoS One 2013; 8:e60936. [PMID: 23805173 PMCID: PMC3689773 DOI: 10.1371/journal.pone.0060936] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 03/04/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Elastin is a signature protein of the arteries and lungs, thus it was hypothesized that elastin is subject to enzymatic degradation during cardiovascular and pulmonary diseases. The aim was to investigate if different fragments of the same protein entail different information associated to two different diseases and if these fragments have the potential of being diagnostic biomarkers. METHODS Monoclonal antibodies were raised against an identified fragment (the ELM-2 neoepitope) generated at the amino acid position '552 in elastin by matrix metalloproteinase (MMP) -9/-12. A newly identified ELM neoepitope was generated by the same proteases but at amino acid position '441. The distribution of ELM-2 and ELM, in human arterial plaques and fibrotic lung tissues were investigated by immunohistochemistry. A competitive ELISA for ELM-2 was developed. The clinical relevance of the ELM and ELM-2 ELISAs was evaluated in patients with acute myocardial infarction (AMI), no AMI, high coronary calcium, or low coronary calcium. The serological release of ELM-2 in patients with chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF) was compared to controls. RESULTS ELM and ELM-2 neoepitopes were both localized in diseased carotid arteries and fibrotic lungs. In the cardiovascular cohort, ELM-2 levels were 66% higher in serum from AMI patients compared to patients with no AMI (p<0.01). Levels of ELM were not significantly increased in these patients and no correlation was observed between ELM-2 and ELM. ELM-2 was not elevated in the COPD and IPF patients and was not correlated to ELM. ELM was shown to be correlated with smoking habits (p<0.01). CONCLUSIONS The ELM-2 neoepitope was related to AMI whereas the ELM neoepitope was related to pulmonary diseases. These results indicate that elastin neoepitopes generated by the same proteases but at different amino acid sites provide different tissue-related information depending on the disease in question.
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Affiliation(s)
- Helene Skjøt-Arkil
- Nordic Bioscience A/S, Herlev, Denmark
- School of Endocrinology, University of Southern Denmark, Odense, Denmark
| | | | - Lars M. Rasmussen
- Institute of Clinical Research, Odense University Hospital, Odense, Denmark
| | | | - Yaguo Wang
- Nordic Bioscience Beijing, Beijing, China
| | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine and Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Cory M. Hogaboam
- Division of Pulmonary and Critical Care Medicine and Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - MeiLan Han
- Division of Pulmonary and Critical Care Medicine and Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Martin R. Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Arkadiusz Nawrocki
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Ben Vainer
- Department of Pathology, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dorrit Krustrup
- Department of Pathology, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
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Mols RE, Sand NP, Jensen JM, Thomsen K, Diederichsen ACP, Nørgaard BL. Social factors and coping status in asymptomatic middle-aged Danes: Association to coronary artery calcification. Scand J Public Health 2013; 41:737-43. [DOI: 10.1177/1403494813492032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims: Understanding the determinants of social and coping inequalities in subclinical cardiovascular disease is an important prerequisite in developing and implementing preventive strategies. The aim of this study was to investigate the association between social factors and coping status, respectively, and subclinical coronary artery disease (CAD) in middle-aged Danes. Methods: This is a DanRisk screening substudy, thus including healthy Danish males and females aged 50 or 60 years. Social measures included grade of education, employment and co-habiting status. The coping status was estimated by the general self-efficacy (GES) scale. Coronary artery calcification (CAC) was assessed by computed tomography using the Agatston score (AS). Conventional clinical risk factors included sex, family history of CAD, BMI > 25, smoking, hypercholesterolaemia and hypertension. Results: In 568 individuals the prevalence of subjects with CAC was 267 (45%). Independent predictors of CAC in males were age (OR = 1.10, 95% CI = 1.04–1.16, p < 0.001), smoking (OR = 1.75, 95% CI = 1.03–2.99, p = 0.038), and low co-habiting status (OR = 3.66, 95% CI = 1.19–11.25, p = 0.023). Independent predictors in females were age (OR = 1.67, 95% CI = 1.02–1.12, p = 0.006), and smoking (OR = 1.71, 95% CI = 1.06–2.78, p = 0.029). Higher AS was associated to lower employment level in females ( p = 0.001) but not in males ( p = 0.833). Conclusions: Social factors are associated to the prevalence and severity of CAC in asymptomatic middle-aged individuals with gender differences. The relative value of gender specific social versus conventional clinical risk factors in the risk assessment of subclinical CAC in middle-aged individuals needs further investigation in future prospective studies.
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Affiliation(s)
| | | | | | | | | | - Bjarne Linde Nørgaard
- Department of Cardiology, Lillebaelt Hospital-Vejle, Denmark
- Department of Cardiology, Aarhus University Hospital-Skejby, Denmark
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Vinholt PJ, Overgaard M, Diederichsen ACP, Mickley H, Poulsen TS, Sand NPR, Nybo M, Rasmussen LM. An ELISA for the quantitation of von Willebrand factor: osteoprotegerin complexes in plasma. Thromb Res 2013; 131:396-400. [PMID: 23531238 DOI: 10.1016/j.thromres.2013.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/22/2013] [Accepted: 03/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Von Willebrand factor (VWF) is pivotal in arterial thrombosis, and osteoprotegerin (OPG) is besides being a bone protein also related to cardiovascular diseases. OPG can bind VWF, but the significance of this interaction is not known. OBJECTIVES The aim was to develop an assay for measurement of von Willebrand factor-osteoprotegerin complex (VWF:OPG) in human plasma. Furthermore, the significance of VWF:OPG complex as a marker of cardiovascular disease (CVD) was evaluated. PATIENTS/METHODS A sandwich ELISA for quantification of VWF:OPG was developed using a polyclonal rabbit anti-human VWF capturing antibody and a monoclonal anti-human OPG detecting antibody. Samples were quantified relative to a standard curve obtained from dilutions of a plasma pool from healthy individuals. The assay was evaluated in two groups of patients with CVD and two groups of asymptomatic individuals with and without documented coronary calcification (total n=118). RESULTS AND CONCLUSIONS The assay detected VWF:OPG complexes in human plasma, while no significant signal was observed when testing solutions containing VWF or recombinant OPG alone. Importantly, the ELISA assay was able to detect in vitro formed complexes between human VWF and recombinant OPG in a dose-dependent manner. There was a large inter-individual variation in plasma VWF:OPG levels, but we found no significant differences in the level of VWF:OPG complexes between the four groups. Thus, we conclude that increasing OPG plasma levels in atherosclerotic CVD are not derived from increased levels of complexed form of VWF and OPG, but are more likely due to increased amounts of OPG secreted into the circulation.
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Affiliation(s)
- Pernille J Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, DK-5000 Odense C, Denmark.
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Scholze A, Bladbjerg EM, Sidelmann JJ, Diederichsen ACP, Mickley H, Nybo M, Argraves WS, Marckmann P, Rasmussen LM. Plasma concentrations of extracellular matrix protein fibulin-1 are related to cardiovascular risk markers in chronic kidney disease and diabetes. Cardiovasc Diabetol 2013; 12:6. [PMID: 23294625 PMCID: PMC3570481 DOI: 10.1186/1475-2840-12-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/03/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fibulin-1 is one of a few extracellular matrix proteins present in blood in high concentrations. We aimed to define the relationship between plasma fibulin-1 levels and risk markers of cardiovascular disease. METHODS Plasma fibulin-1 was determined in subjects with chronic kidney disease (n = 32; median age 62.5, inter-quartile range 51 - 73 years) and 60 age-matched control subjects. Among kidney disease patients serological biomarkers related to cardiovascular disease (fibrinogen, interleukin 6, C-reactive protein) were measured. Arterial applanation tonometry was used to determine central hemodynamic and arterial stiffness indices. RESULTS We observed a positive correlation of fibulin-1 levels with age (r = 0.38; p = 0.033), glycated hemoglobin (r = 0.80; p = 0.003), creatinine (r = 0.35; p = 0.045), and fibrinogen (r = 0.39; p = 0.027). Glomerular filtration rate and fibulin-1 were inversely correlated (r = -0.57; p = 0.022). There was a positive correlation between fibulin-1 and central pulse pressure (r = 0.44; p = 0.011) and central augmentation pressure (r = 0.55; p = 0.001). In a multivariable regression model, diabetes, creatinine, fibrinogen and central augmentation pressure were independent predictors of plasma fibulin-1. CONCLUSION Increased plasma fibulin-1 levels were associated with diabetes and impaired kidney function. Furthermore, fibulin-1 levels were associated with hemodynamic cardiovascular risk markers. Fibulin-1 is a candidate in the pathogenesis of cardiovascular disease observed in chronic kidney disease and diabetes.
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Affiliation(s)
- Alexandra Scholze
- Clinical Research Unit, Department of Nephrology, Odense University Hospital, Odense, Denmark.
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Brogaard HVT, Køhn MG, Berget OS, Hansen HS, Gerke O, Mickley H, Diederichsen ACP. Significant improvement in statin adherence and cholesterol levels after acute myocardial infarction. Dan Med J 2012; 59:A4509. [PMID: 22951203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time. MATERIAL AND METHODS Data from two cohorts of AMI patients discharged from the Department of Cardiology, Odense University Hospital, in 2003 (n = 474, mean age 68 years, 66% males) and 2008 (n = 550, mean age 67 years, 69% males) were compared. Based on the number of tablets collected at the pharmacy, patients' adherence to statin treatment in a period of two years after discharge was analysed. Patients were considered adherent when in possession of medication ≥ 80% of the period. From the day of admission and at follow-up, cholesterol values and the relative number of patients with a total-cholesterol < 4.5 mmol/l were calculated. RESULTS A significant improvement in statin adherence was noted: 42% versus 75% (p < 0.0001). The most significant difference was observed in patients ≥ 80 years, who improved from 25% to 72% (p < 0.0001). Furthermore, an overall significant reduction in follow-up cholesterol levels was observed: from 4.4 to 4.2 mmol/l (p = 0.003). More-over, an increase was observed in the proportion of patients with a follow-up cholesterol value < 4.5 mmol/l: from 57% to 67% (p = 0.001). The most significant changes were demonstrated in patients ≥ 70 years. CONCLUSION Over the five-year period from 2003 to 2008, statin adherence and cholesterol values significantly improved. However, room for improvement remains, particularly in younger patients. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Lambrechtsen J, Gerke O, Egstrup K, Sand NP, Nørgaard BL, Petersen H, Mickley H, Diederichsen ACP. The relation between coronary artery calcification in asymptomatic subjects and both traditional risk factors and living in the city centre: a DanRisk substudy. J Intern Med 2012; 271:444-50. [PMID: 22092933 DOI: 10.1111/j.1365-2796.2011.02486.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the association between the risk factor for living in the city centre as a surrogate for air pollution and the presence of coronary artery calcification (CAC) in a population of asymptomatic Danish subjects. DESIGN AND SUBJECTS A random sample of 1825 men and women of either 50 or 60 years of age were invited to take part in a screening project designed to assess risk factors for cardiovascular disease (CVD). Noncontrast cardiac computed tomography was performed on all subjects, and their Agatston scores were calculated to evaluate the presence of subclinical coronary atherosclerosis. The relationship between CAC and several demographic and clinical parameters was evaluated using multivariate logistic regression. RESULTS A total of 1225 individuals participated in the study, of whom 250 (20%) were living in the centres of major Danish cities. Gender and age showed the greatest association with the presence of CAC: the odds ratio (OR) for men compared with women was 3.2 [95% confidence interval (CI) 2.5-4.2; P < 0.0001], and the OR for subjects aged 60 versus those aged 50 years was 2.2 (95% CI 1.7-2.8; P < 0.0001). Other variables independently associated with the presence of CAC were diabetes and smoking with ORs of 2.0 (95% CI 1.1-3.5; P = 0.03) and 1.9 (95% CI 1.4-2.5, P < 0.0001), respectively. The adjusted OR for subjects living in city centres compared to those living outside was 1.8 (95% CI 1.3-2.4; P = 0.0003). CONCLUSION Both conventional risk factors for CVD and living in a city centre are independently associated with the presence of CAC in asymptomatic middle-aged subjects.
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Affiliation(s)
- J Lambrechtsen
- Department of Cardiology, Svendborg Hospital, Svendborg.
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Diederichsen ACP, Petersen H, Jensen LO, Thayssen P, Gerke O, Sandgaard NCF, Høilund-Carlsen PF, Mickley H. Diagnostic value of cardiac 64-slice computed tomography: importance of coronary calcium. SCAND CARDIOVASC J 2010; 43:337-44. [PMID: 19266395 DOI: 10.1080/14017430902785501] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Coronary computed tomography angiography (CTA) has proven clinically useful for non-invasive assessment of coronary pathology. However, coronary calcium can reduce its diagnostic value. The objective of this study was to define a calcium score above which CTA appears less reliable. DESIGN We prospectively investigated 109 patients referred for elective coronary angiography (CA). With a 64-slice CT-scanner, coronary calcium was determined and expressed in Agatston unit (AU). A significant coronary stenosis was defined as > or =50% luminal diameter reduction. Following blinded interpretation, diagnostic values of CTA at different levels of AU were calculated using quantitative CA as reference. RESULTS A strong association with stent and the severity of coronary calcium was observed. In patients without stents (n = 91) sensitivity, specificity and positive and negative predictive value for presence of significant stenosis were: 100%, 91%, 74%, and 100% in patients with a calcium score < or =400 AU versus 100%, 17%, 75%, and 100% in patients with a score >400 AU. CONCLUSIONS The diagnostic accuracy of CTA in patients with no or little coronary calcium is excellent. However, in patients with an Agatston score >400 specificity declines and therefore, these patients should not go on to CTA, but be referred to CA instead.
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Diederichsen ACP, Møller JE, Thayssen P, Videbaek L, Saekmose SG, Barington T, Kassem M. Changes in left ventricular filling patterns after repeated injection of autologous bone marrow cells in heart failure patients. SCAND CARDIOVASC J 2010; 44:139-45. [PMID: 20233136 DOI: 10.3109/14017430903556294] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We have previously shown that repeated intracoronary infusion of bone marrow cells (BMSC) did not improve left ventricular (LV) ejection fraction in patients with chronic ischemic heart failure. However, the impact of BMSC therapy on LV diastolic filling has remained uncertain. DESIGN Thirty two patients with LV ejection fraction less than 40% were studied. Each patient underwent three baseline echocardiograms to ensure stable LV filling. Infusion of BMSC was given at baseline and again after four months. Echocardiograms were repeated four, eight and 12 months after the first intervention. Main outcome measures were the ratio of transmitral flow (E) velocity to early mitral annulus (e') velocity (E/e'), left atrial (LA) volume and plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro-BNP). RESULTS During the initial observational period there were no changes in main outcome. After treatment with intracoronary BMSC a significant decrease was observed in E/e' ratio (14.7+/-6.7 vs. 13.2+/-7.7, p=0.04), LA volume (90+/-25 ml vs. 80+/-26 ml, p=0.006) and plasma NT-pro-BNP (p=0.03). The effect was greatest in patients who received the largest amount of CD34(+) cells. CONCLUSION In this non-randomised study repeated intracoronary BMSC infusions had a beneficial effect on LV filling in patients with chronic ischemic heart failure. Randomised studies are warranted.
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Diederichsen ACP, Hjelmborg JVB, Christensen PB, Zeuthen J, Fenger C. Prognostic value of the CD4+/CD8+ ratio of tumour infiltrating lymphocytes in colorectal cancer and HLA-DR expression on tumour cells. Cancer Immunol Immunother 2003; 52:423-8. [PMID: 12695859 PMCID: PMC11032970 DOI: 10.1007/s00262-003-0388-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2002] [Accepted: 01/30/2003] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to clarify whether HLA-DR expression of colorectal tumour cells or the CD4+/CD8+ ratio of the tumour infiltrating lymphocytes is significantly associated with the prognosis of colorectal cancer. Using flow cytometry, we studied the tumour cell expression of the HLA class II in 70 enzymatically dissociated colorectal cancers and the phenotype of tumour infiltrating lymphocytes (TILs) in 41 cases. There was no trend in 5-year survival between three levels (low, medium, high) of HLA-DR expression on the tumour cells. Patients with low CD4+/CD8+ ratios had a better clinical course, with significantly higher 5-year survival, p=0.046, independent of the Dukes stage and age. Our results have implications for tumour immunology; colorectal cancer cells might be a target for cytotoxic T-lymphocytes, however the tumour cells are not able to initiate an immune response. Stimulation of the immune system could possible be obtained using dendritic cells cultured in vitro and loaded with tumour antigens.
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Affiliation(s)
- Axel C P Diederichsen
- Biomedical Laboratory, University of Southern Denmark, Winsløwparken 23, 5000 Odense C, Denmark.
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Diederichsen ACP, Christensen I. [Clinical heart arrest after emergency "direct current" cardioversion of atrial flutter]. Ugeskr Laeger 2003; 165:585-6. [PMID: 12608028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A rare case of clinical cardiac arrest after acute DC cardioversion is presented. The patient was a 64-year-old man with acute haemodynamically unstable atrial flutter. He was known to have had episodes of atrial flutter requiring DC cardioversion, and he was treated with propafenone (300 mg twice daily). Synchronised DC cardioversion resulted in cardiac arrest. Resuscitation was initiated and after 2-3 minutes the patient regained sinus rhythm and pulse. There were no sequelae. We conclude that cardiac arrest is a rare complication to DC cardioversion.
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Diederichsen ACP, Rasmussen JM. [Watermelon stomach and scleroderma]. Ugeskr Laeger 2002; 164:2047. [PMID: 11985006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
We report here a 72-year-old man with severe, persistent, iron deficiency anaemia. Upper gastrointestinal endoscopy revealed red stripes radiating to the pylorus, characteristic of watermelon stomach (gastric antral vascular ectasia). The patient was found to have scleroderma with calcinosis, sclerodactyly, and telangiectasias, but neither Raynaud's phenomenon nor oesophageal dysmotility. The patient was treated with endoscopic Argon laser therapy, repeated six times, but this did not control the bleeding. Altogether the patient received 62 units of blood transfusions. The patient died after 9 months.
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