Jens Hove | University of Copenhagen (original) (raw)

Papers by Jens Hove

Research paper thumbnail of Renal and circulatory effects of terlipressin in patients with hepatorenal syndrome assessed by magnetic resonance imaging

Research paper thumbnail of Blunted cardiovascular effects of beta-blockers in patients with cirrhosis: relation to severity?

Research paper thumbnail of Left atrial volume changes assessed by real time 3-dimensional echocardiography in relation to liver function and prognosis in patients with cirrhosis

The International Journal of Cardiovascular Imaging, 2020

Left atrial enlargement is a known marker of chronic diastolic dysfunction and was recently shown... more Left atrial enlargement is a known marker of chronic diastolic dysfunction and was recently shown to be an independent predictor of mortality in cirrhosis. Real time 3-dimensional echocardiography (3DE) is an emerging modality that enables accurate measurements of the left atrial (LA) volume and function. Assessment of LA volumes with 3DE has never been applied in cases of cirrhosis. We therefore aimed to investigate LA volumes using the novel 3DE technique in relation to liver dysfunction and outcome in patients with cirrhosis. A prospective study of 47 cirrhotic patients without cardiovascular disease and ten healthy controls. The patients underwent clinical evaluation, blood sampling, liver vein catheterization, ECG and tissue Doppler echocardiography, including 3DE. Patients were followed up for a median of 25 months with registration of death and liver transplantation (LT). 3DE-derived maximal left atrial volume index (LAVImax) and minimal left atrial volume index (LAVImin) were higher in patients with a Child Pugh score of 8 or higher than in patients with a score lower than 8 (30.0 vs. 22.3 mL/m2, P=0.008 and 14.6 vs. 9.5 mL/m2, P=0.04, respectively). LA volumes correlated with model for end-stage liver disease (MELD) score (r=0.40, P=0.005), hepatic venous pressure gradient (r=0.34, P=0.04), and biochemical markers of advanced liver disease. Twelve patients experienced the composite end-point of death or LT during follow-up and these patients had increased LA volumes with a higher LAVImax (34.3±14.8 vs. 25.9±7.3 mL/m2, P=0.01) and a higher LAVImin (16.3±7.3 vs. 10.8±5.1 mL/m2, P=0.007). Patients with advanced cirrhosis have increased minimal and maximal left atrial volumes, which correlate with the degree of the liver dysfunction and poor prognosis.

Research paper thumbnail of Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging

European Heart Journal – Cardiovascular Imaging, 2016

Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantita... more Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flow and cardiac chamber volume quantification. We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MI Vol) related to severe MI. Methods and results In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MI Vol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Ao flow). With increasing MI severity, MI Vol , left heart volumes, and pulmonary venous diameters increased (P , 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MI Vol .40 mL, MI regurgitant fraction .0.30, LV end-diastolic volume (LVEDV (i)) .108 mL m 22 , and a total left heart volume .188 mL m 22 with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio .1.2. In severe MI, LV ejection fraction was unaffected, but the Ao flow and the peak ejection rate indexed to LVEDV were lowered (P , 0.05). In surgical patients, the MI Vol correlated to the decrease in LV dimension after valve surgery (P , 0.02). Conclusion CMR provides a reproducible quantitative technique for evaluation of MI, as MI Vol and cardiac chamber volumes can be held against diagnostic cutoff values. The Ao flow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.

Research paper thumbnail of The composition of the bile acid pool is closely associated with fibrosis in the heart and liver of patients with cirrhosis

Research paper thumbnail of Increased levels of soluble mannose receptor are associated with poor outcome in cirrhosis: results from a 2-year longitudinal study

Journal of Hepatology, 2020

Research paper thumbnail of MRI-derived myocardial extracellular volume is closely associated with markers of collagen formation in cirrhosis

Journal of Hepatology, 2020

Research paper thumbnail of Human bronchial artery blood flow after lung Tx with direct bronchial artery revascularization

Journal of Applied Physiology, 1999

The inaccuracy of measuring human bronchial artery blood flow has previously been considerable. E... more The inaccuracy of measuring human bronchial artery blood flow has previously been considerable. En bloc double-lung transplantation with bronchial artery revascularization (BAR) using a single conduit offers the unique opportunity of direct measurement of the total bronchial artery blood flow. In eight en bloc double-lung-transplanted patients with complete BAR, the basal blood flow was measured by using a 0.014-in. Doppler guide wire and arteriography. The average peak velocity in the conduit was 12–73 cm/s [±2.1 (SD) cm/s], and the conduit diameter was 1.7–3.1 mm [±0.10 (SD) mm], giving individual basal flow values between 19 and 67 ml/min [±5 (SD) ml/min], or 0.2–1.9% of estimated cardiac output. In three patients basal measurements were followed by injection of nitroglycerin and verapamil into the conduit. This increased the bronchial artery flow to 121–262% of basal values (31–89 ml/min). The measured values appear more physiologically plausible than previous bronchial artery b...

Research paper thumbnail of SAT-027-Effects of propranolol on liver- and spleen-stiffness measured by MR-Elastography in patients with cirrhosis

Journal of Hepatology, 2019

Research paper thumbnail of SAT-138-Cirrhotic cardiomyopathy: A 2-year longitudinal follow-up study using advanced cardiac imaging

Journal of Hepatology, 2019

Research paper thumbnail of Pronounced Coronary Arteriosclerosis in Cirrhosis: Influence on Cardiac Function and Survival?

Digestive Diseases and Sciences, 2018

BackgroundThe relation between excessive alcohol consumption and coronary arteriosclerosis has re... more BackgroundThe relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT angiography is a robust marker of coronary arteriosclerosis.AimsTo study the burden of coronary arteriosclerosis in cirrhotic patients of various etiologies and association to cardiac dysfunction and survival.MethodsFifty-seven patients with cirrhosis without cardiovascular disease underwent coronary CT angiography, tissue Doppler echocardiography, electrocardiogram and registration of clinical and biochemical characteristics.ResultsIn patients with cirrhosis the median coronary artery calcium-score was increased in comparison with age and race-adjusted healthy reference values (men: 328 vs. 9 HU and women: 136 vs. 0 HU; p < 0.001). Moreover, the coronary artery calcium-score in alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p < 0.001). Coronary artery calcium-score correlated with age (p = 0.002) but not with established cardiovascular risk factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died but coronary artery calcium-score was not associated with survival.ConclusionsCoronary arteriosclerosis was particular extensive in patients with alcoholic cirrhosis. However, the current results suggest that coronary arteriosclerosis only have limited influence on cardiac function and survival. Surprisingly, no other established risk factors apart from age seemed to interfere with coronary arteriosclerosis in cirrhotic patients.

Research paper thumbnail of Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Lancet (London, England), 2018

Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and i... more Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30-50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be ...

Research paper thumbnail of Myocardial extracellular volume quantified by magnetic resonance is increased in cirrhosis and related to poor outcome

Liver international : official journal of the International Association for the Study of the Liver, 2018

The underlying pathogenesis of cirrhotic cardiomyopathy remains unclear. Structural myocardial ch... more The underlying pathogenesis of cirrhotic cardiomyopathy remains unclear. Structural myocardial changes including diffuse fibrosis may be involved and can be accurately assessed by cardiac MRI (CMR) with quantification of the extracellular volume (ECV).This is the first application of this technique in patients with cirrhosis. We aimed to investigate the presence of diffuse myocardial fibrosis and to determine the relation to disease severity, cardiac function and outcome. A prospective study including 52 cirrhotic patients and 10 healthy controls. All patients underwent CMR with ECV quantification, tissue Doppler echocardiography, and biochemical assessments. Patients were followed up for a median of 25 months with registration of death and liver transplantation (LT). Myocardial ECV was higher in the patients compared with healthy controls (31.2 ± 6 vs 27.4 ± 3%, P = .04). Furthermore, ECV increased across the Child Pugh A/B/C classes (26.9 ± 4/31.5 ± 5/34.4 ± 6%, P = .02). Four-tee...

Research paper thumbnail of Value of Myocardial Perfusion Assessment With Coronary Computed Tomography Angiography in Patients With Recent Acute-Onset Chest Pain

JACC. Cardiovascular imaging, Jan 8, 2017

The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of ... more The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of combined examination with coronary computed tomography angiography (CTA) and computed tomography perfusion imaging (CTP) compared to coronary CTA alone. Stress myocardial CTP may increase diagnostic specificity when added to coronary CTA in patients suspected of having ischemic heart disease. Patients recently hospitalized for acute-onset chest pain, in whom acute coronary syndrome had been ruled out by normal electrocardiograms, normal troponin levels, and relief of symptoms, and who had a clinical indication for outpatient noninvasive testing, were screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to examination with coronary CTA or coronary CTA+CTP. The primary endpoint was the frequency of coronary revascularization among patients referred for invasive coronary angiography (ICA) based on index c...

Research paper thumbnail of Total bile acid levels are associated with left atrial volume and cardiac output in patients with cirrhosis

European journal of gastroenterology & hepatology, Jan 8, 2017

Bile acids (BAs) are potent signaling molecules involved in the regulation of several metabolic a... more Bile acids (BAs) are potent signaling molecules involved in the regulation of several metabolic and functional aspects of cardiovascular homeostasis. BA pool alteration in cirrhosis may contribute toward the development of hemodynamic and cardiac disturbances. We aimed to investigate the association between total BA levels and echocardiographic and biochemical markers of cardiac dysfunction in cirrhotic patients. Cirrhotic patients were enrolled prospectively in this hypothesis-generating study and evaluated for cardiac and hemodynamic dysfunction through clinical, echocardiographic, and biochemical means. Associations between total serum BA concentrations and markers of systolic or diastolic dysfunction and the presence of cirrhotic cardiomyopathy were tested through univariate and multivariate analyses. Fifty-eight patients with cirrhosis were assessed in this monocentric study. 49 (85%) patients had decompensated cirrhosis according to the Child class. The median total BA level w...

Research paper thumbnail of Rationale and Design of the First Double-Blind, Placebo-Controlled Trial with Allogeneic Adipose Tissue-Derived Stromal Cell Therapy in Patients with Ischemic Heart Failure: A Phase II Danish Multicentre Study

Stem Cells International, 2017

Background. Ischemic heart failure (IHF) has a poor prognosis in spite of optimal therapy. We hav... more Background. Ischemic heart failure (IHF) has a poor prognosis in spite of optimal therapy. We have established a new allogeneic Cardiology Stem Cell Centre adipose-derived stromal cell (CSCC_ASC) product from healthy donors. It is produced without animal products, in closed bioreactor systems and cryopreserved as an off-the-shelf product ready to use. Study Design. A multicentre, double-blind, placebo-controlled phase II study with direct intramyocardial injections of allogeneic CSCC_ASC in patients with chronic IHF. A total of 81 patients will be randomised at 2 : 1 to CSCC_ASC or placebo. There is no HLA tissue type matching needed between the patients and the donors. Methods. The treatment will be delivered by direct injections into the myocardium. The primary endpoint is change in the left ventricle endsystolic volume at 6-month follow-up. Secondary endpoints are safety and changes in left ventricle ejection fraction, myocardial mass, stroke volume, and cardiac output. Other sec...

Research paper thumbnail of Assessment of systolic function in the evaluation of patients with cirrhosis

Hepatology (Baltimore, Md.), Jan 20, 2017

Research paper thumbnail of Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris

The International Journal of Cardiovascular Imaging, 2016

detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ... more detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ratio of 39 (95 % confidence interval 11-134), p < 0.0001, for visual interpretation and 0.99 (0.98-0.99) for stress TPR, p < 0.0001. Patients with a PD volume covering >10 % of the LV myocardium had a worse prognosis compared to patients with a PD covering <10 % of the LV myocardium, p = 0.0002. The optimal cutoff value of the myocardial PD extent to predict MACE was 5.3 % of the left ventricle [sensitivity 84 % (64-96), specificity 95 % (91-97)]. Myocardial CT perfusion parameters predict mid-term clinical outcome in patients with recent acute-onset chest pain.

Research paper thumbnail of Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

Scandinavian Cardiovascular Journal, 2016

To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients a... more To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed. CCTA detects significant (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50%) coronary artery diameter stenosis with a sensitivity, specificity, and positive and negative predictive value of 99%, 81%, 96% and 95%, respectively. CCTA was used to triage patients into guideline defined treatment groups of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;no or medical treatment&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;referral to percutaneous coronary intervention&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; or to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;coronary artery bypass graft surgery&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and was compared to the index ICA. CCTA correctly triaged patients in 86% of cases. During a median follow-up of 50 months, the presence of an occluded artery by CCTA was associated with adverse outcome. CCTA has high diagnostic and prognostic value in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population.

Research paper thumbnail of Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments

The International Journal of Cardiovascular Imaging, 2016

y CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC... more y CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.

Research paper thumbnail of Renal and circulatory effects of terlipressin in patients with hepatorenal syndrome assessed by magnetic resonance imaging

Research paper thumbnail of Blunted cardiovascular effects of beta-blockers in patients with cirrhosis: relation to severity?

Research paper thumbnail of Left atrial volume changes assessed by real time 3-dimensional echocardiography in relation to liver function and prognosis in patients with cirrhosis

The International Journal of Cardiovascular Imaging, 2020

Left atrial enlargement is a known marker of chronic diastolic dysfunction and was recently shown... more Left atrial enlargement is a known marker of chronic diastolic dysfunction and was recently shown to be an independent predictor of mortality in cirrhosis. Real time 3-dimensional echocardiography (3DE) is an emerging modality that enables accurate measurements of the left atrial (LA) volume and function. Assessment of LA volumes with 3DE has never been applied in cases of cirrhosis. We therefore aimed to investigate LA volumes using the novel 3DE technique in relation to liver dysfunction and outcome in patients with cirrhosis. A prospective study of 47 cirrhotic patients without cardiovascular disease and ten healthy controls. The patients underwent clinical evaluation, blood sampling, liver vein catheterization, ECG and tissue Doppler echocardiography, including 3DE. Patients were followed up for a median of 25 months with registration of death and liver transplantation (LT). 3DE-derived maximal left atrial volume index (LAVImax) and minimal left atrial volume index (LAVImin) were higher in patients with a Child Pugh score of 8 or higher than in patients with a score lower than 8 (30.0 vs. 22.3 mL/m2, P=0.008 and 14.6 vs. 9.5 mL/m2, P=0.04, respectively). LA volumes correlated with model for end-stage liver disease (MELD) score (r=0.40, P=0.005), hepatic venous pressure gradient (r=0.34, P=0.04), and biochemical markers of advanced liver disease. Twelve patients experienced the composite end-point of death or LT during follow-up and these patients had increased LA volumes with a higher LAVImax (34.3±14.8 vs. 25.9±7.3 mL/m2, P=0.01) and a higher LAVImin (16.3±7.3 vs. 10.8±5.1 mL/m2, P=0.007). Patients with advanced cirrhosis have increased minimal and maximal left atrial volumes, which correlate with the degree of the liver dysfunction and poor prognosis.

Research paper thumbnail of Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging

European Heart Journal – Cardiovascular Imaging, 2016

Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantita... more Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flow and cardiac chamber volume quantification. We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MI Vol) related to severe MI. Methods and results In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MI Vol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Ao flow). With increasing MI severity, MI Vol , left heart volumes, and pulmonary venous diameters increased (P , 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MI Vol .40 mL, MI regurgitant fraction .0.30, LV end-diastolic volume (LVEDV (i)) .108 mL m 22 , and a total left heart volume .188 mL m 22 with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio .1.2. In severe MI, LV ejection fraction was unaffected, but the Ao flow and the peak ejection rate indexed to LVEDV were lowered (P , 0.05). In surgical patients, the MI Vol correlated to the decrease in LV dimension after valve surgery (P , 0.02). Conclusion CMR provides a reproducible quantitative technique for evaluation of MI, as MI Vol and cardiac chamber volumes can be held against diagnostic cutoff values. The Ao flow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.

Research paper thumbnail of The composition of the bile acid pool is closely associated with fibrosis in the heart and liver of patients with cirrhosis

Research paper thumbnail of Increased levels of soluble mannose receptor are associated with poor outcome in cirrhosis: results from a 2-year longitudinal study

Journal of Hepatology, 2020

Research paper thumbnail of MRI-derived myocardial extracellular volume is closely associated with markers of collagen formation in cirrhosis

Journal of Hepatology, 2020

Research paper thumbnail of Human bronchial artery blood flow after lung Tx with direct bronchial artery revascularization

Journal of Applied Physiology, 1999

The inaccuracy of measuring human bronchial artery blood flow has previously been considerable. E... more The inaccuracy of measuring human bronchial artery blood flow has previously been considerable. En bloc double-lung transplantation with bronchial artery revascularization (BAR) using a single conduit offers the unique opportunity of direct measurement of the total bronchial artery blood flow. In eight en bloc double-lung-transplanted patients with complete BAR, the basal blood flow was measured by using a 0.014-in. Doppler guide wire and arteriography. The average peak velocity in the conduit was 12–73 cm/s [±2.1 (SD) cm/s], and the conduit diameter was 1.7–3.1 mm [±0.10 (SD) mm], giving individual basal flow values between 19 and 67 ml/min [±5 (SD) ml/min], or 0.2–1.9% of estimated cardiac output. In three patients basal measurements were followed by injection of nitroglycerin and verapamil into the conduit. This increased the bronchial artery flow to 121–262% of basal values (31–89 ml/min). The measured values appear more physiologically plausible than previous bronchial artery b...

Research paper thumbnail of SAT-027-Effects of propranolol on liver- and spleen-stiffness measured by MR-Elastography in patients with cirrhosis

Journal of Hepatology, 2019

Research paper thumbnail of SAT-138-Cirrhotic cardiomyopathy: A 2-year longitudinal follow-up study using advanced cardiac imaging

Journal of Hepatology, 2019

Research paper thumbnail of Pronounced Coronary Arteriosclerosis in Cirrhosis: Influence on Cardiac Function and Survival?

Digestive Diseases and Sciences, 2018

BackgroundThe relation between excessive alcohol consumption and coronary arteriosclerosis has re... more BackgroundThe relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT angiography is a robust marker of coronary arteriosclerosis.AimsTo study the burden of coronary arteriosclerosis in cirrhotic patients of various etiologies and association to cardiac dysfunction and survival.MethodsFifty-seven patients with cirrhosis without cardiovascular disease underwent coronary CT angiography, tissue Doppler echocardiography, electrocardiogram and registration of clinical and biochemical characteristics.ResultsIn patients with cirrhosis the median coronary artery calcium-score was increased in comparison with age and race-adjusted healthy reference values (men: 328 vs. 9 HU and women: 136 vs. 0 HU; p < 0.001). Moreover, the coronary artery calcium-score in alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p < 0.001). Coronary artery calcium-score correlated with age (p = 0.002) but not with established cardiovascular risk factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died but coronary artery calcium-score was not associated with survival.ConclusionsCoronary arteriosclerosis was particular extensive in patients with alcoholic cirrhosis. However, the current results suggest that coronary arteriosclerosis only have limited influence on cardiac function and survival. Surprisingly, no other established risk factors apart from age seemed to interfere with coronary arteriosclerosis in cirrhotic patients.

Research paper thumbnail of Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Lancet (London, England), 2018

Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and i... more Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30-50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be ...

Research paper thumbnail of Myocardial extracellular volume quantified by magnetic resonance is increased in cirrhosis and related to poor outcome

Liver international : official journal of the International Association for the Study of the Liver, 2018

The underlying pathogenesis of cirrhotic cardiomyopathy remains unclear. Structural myocardial ch... more The underlying pathogenesis of cirrhotic cardiomyopathy remains unclear. Structural myocardial changes including diffuse fibrosis may be involved and can be accurately assessed by cardiac MRI (CMR) with quantification of the extracellular volume (ECV).This is the first application of this technique in patients with cirrhosis. We aimed to investigate the presence of diffuse myocardial fibrosis and to determine the relation to disease severity, cardiac function and outcome. A prospective study including 52 cirrhotic patients and 10 healthy controls. All patients underwent CMR with ECV quantification, tissue Doppler echocardiography, and biochemical assessments. Patients were followed up for a median of 25 months with registration of death and liver transplantation (LT). Myocardial ECV was higher in the patients compared with healthy controls (31.2 ± 6 vs 27.4 ± 3%, P = .04). Furthermore, ECV increased across the Child Pugh A/B/C classes (26.9 ± 4/31.5 ± 5/34.4 ± 6%, P = .02). Four-tee...

Research paper thumbnail of Value of Myocardial Perfusion Assessment With Coronary Computed Tomography Angiography in Patients With Recent Acute-Onset Chest Pain

JACC. Cardiovascular imaging, Jan 8, 2017

The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of ... more The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of combined examination with coronary computed tomography angiography (CTA) and computed tomography perfusion imaging (CTP) compared to coronary CTA alone. Stress myocardial CTP may increase diagnostic specificity when added to coronary CTA in patients suspected of having ischemic heart disease. Patients recently hospitalized for acute-onset chest pain, in whom acute coronary syndrome had been ruled out by normal electrocardiograms, normal troponin levels, and relief of symptoms, and who had a clinical indication for outpatient noninvasive testing, were screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to examination with coronary CTA or coronary CTA+CTP. The primary endpoint was the frequency of coronary revascularization among patients referred for invasive coronary angiography (ICA) based on index c...

Research paper thumbnail of Total bile acid levels are associated with left atrial volume and cardiac output in patients with cirrhosis

European journal of gastroenterology & hepatology, Jan 8, 2017

Bile acids (BAs) are potent signaling molecules involved in the regulation of several metabolic a... more Bile acids (BAs) are potent signaling molecules involved in the regulation of several metabolic and functional aspects of cardiovascular homeostasis. BA pool alteration in cirrhosis may contribute toward the development of hemodynamic and cardiac disturbances. We aimed to investigate the association between total BA levels and echocardiographic and biochemical markers of cardiac dysfunction in cirrhotic patients. Cirrhotic patients were enrolled prospectively in this hypothesis-generating study and evaluated for cardiac and hemodynamic dysfunction through clinical, echocardiographic, and biochemical means. Associations between total serum BA concentrations and markers of systolic or diastolic dysfunction and the presence of cirrhotic cardiomyopathy were tested through univariate and multivariate analyses. Fifty-eight patients with cirrhosis were assessed in this monocentric study. 49 (85%) patients had decompensated cirrhosis according to the Child class. The median total BA level w...

Research paper thumbnail of Rationale and Design of the First Double-Blind, Placebo-Controlled Trial with Allogeneic Adipose Tissue-Derived Stromal Cell Therapy in Patients with Ischemic Heart Failure: A Phase II Danish Multicentre Study

Stem Cells International, 2017

Background. Ischemic heart failure (IHF) has a poor prognosis in spite of optimal therapy. We hav... more Background. Ischemic heart failure (IHF) has a poor prognosis in spite of optimal therapy. We have established a new allogeneic Cardiology Stem Cell Centre adipose-derived stromal cell (CSCC_ASC) product from healthy donors. It is produced without animal products, in closed bioreactor systems and cryopreserved as an off-the-shelf product ready to use. Study Design. A multicentre, double-blind, placebo-controlled phase II study with direct intramyocardial injections of allogeneic CSCC_ASC in patients with chronic IHF. A total of 81 patients will be randomised at 2 : 1 to CSCC_ASC or placebo. There is no HLA tissue type matching needed between the patients and the donors. Methods. The treatment will be delivered by direct injections into the myocardium. The primary endpoint is change in the left ventricle endsystolic volume at 6-month follow-up. Secondary endpoints are safety and changes in left ventricle ejection fraction, myocardial mass, stroke volume, and cardiac output. Other sec...

Research paper thumbnail of Assessment of systolic function in the evaluation of patients with cirrhosis

Hepatology (Baltimore, Md.), Jan 20, 2017

Research paper thumbnail of Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris

The International Journal of Cardiovascular Imaging, 2016

detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ... more detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ratio of 39 (95 % confidence interval 11-134), p < 0.0001, for visual interpretation and 0.99 (0.98-0.99) for stress TPR, p < 0.0001. Patients with a PD volume covering >10 % of the LV myocardium had a worse prognosis compared to patients with a PD covering <10 % of the LV myocardium, p = 0.0002. The optimal cutoff value of the myocardial PD extent to predict MACE was 5.3 % of the left ventricle [sensitivity 84 % (64-96), specificity 95 % (91-97)]. Myocardial CT perfusion parameters predict mid-term clinical outcome in patients with recent acute-onset chest pain.

Research paper thumbnail of Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

Scandinavian Cardiovascular Journal, 2016

To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients a... more To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed. CCTA detects significant (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50%) coronary artery diameter stenosis with a sensitivity, specificity, and positive and negative predictive value of 99%, 81%, 96% and 95%, respectively. CCTA was used to triage patients into guideline defined treatment groups of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;no or medical treatment&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;referral to percutaneous coronary intervention&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; or to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;coronary artery bypass graft surgery&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and was compared to the index ICA. CCTA correctly triaged patients in 86% of cases. During a median follow-up of 50 months, the presence of an occluded artery by CCTA was associated with adverse outcome. CCTA has high diagnostic and prognostic value in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population.

Research paper thumbnail of Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments

The International Journal of Cardiovascular Imaging, 2016

y CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC... more y CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, κ = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (κ = 0.61, κ = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (κ = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: ±2.03, ±1.96, ±1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.