Publications (24)47.05 Total impact
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Article: Prognosis in patients with suspected or known ischemic heart disease and normal myocardial perfusion: Long-term outcome and temporal risk variations.
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ABSTRACT: BACKGROUND: The prognostic value of a normal myocardial perfusion scintigraphy (MPS) may be well described, but long-term follow-up data are sparse, and temporal variations in risk are insufficiently elucidated. METHODS AND RESULTS: During long-term follow-up (mean 6.2 years) of 1,327 consecutive Danish patients with normal MPS, the rate of all-cause death (ACD) was 1.9%/year (differing by gender) and of cardiac death (CD)/myocardial infarction (MI) 0.8%/year (differing by coronary artery disease, CAD). Female gender (HR: 0.60), age (HR: 1.07 per-year increment), and known CAD without prior revascularization (HR: 2.17) were statistically significant factors for ACD, whereas diabetes and previous MI per se were not. Known CAD with previous revascularization carried a low risk of ACD when adjusted for gender and age (HR: 0.56). For CD/MI, risk increased with age and threefold with known CAD, previous MI, and previous percutaneous coronary intervention. Judged from smoothed hazard functions, mortality risk increased further with time for men, elderly, and diabetics and markedly further with known CAD without prior revascularization. CONCLUSIONS: Following a normal MPS, rates of death and hard cardiac events were low. Risk varied with age, gender, and disease history. Novel aspects of temporal risk variation suggested a general warranty period of 5 years, but less in risk groups.Journal of Nuclear Cardiology 03/2013; · 2.67 Impact Factor -
Article: A randomized clinical trial of chiropractic treatment and self-management in patients with acute musculoskeletal chest pain: 1-year follow-up.
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ABSTRACT: We have previously reported short-term follow-up from a pragmatic randomized clinical trial comparing 2 treatments for acute musculoskeletal chest pain: (1) chiropractic treatment and (2) self-management. Results indicated a positive effect in favor of the chiropractic treatment after 4 and 12 weeks. The current article investigates the hypothesis that the advantage observed at 4 and 12 weeks would be sustained after 1 year. In addition, we describe self-reported consequences of acute musculoskeletal chest pain at 1-year follow-up. In a nonblinded, randomized controlled trial undertaken at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain of musculoskeletal origin were included. After the baseline evaluation, patients were randomized to 4 weeks of either chiropractic treatment or self-management, with posttreatment questionnaire follow-up 52 weeks later. The primary outcome measures were change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale). Both groups experienced decreases in pain, positive global, self-perceived treatment effect, and increases in the 36-Item Short Form Health Survey scores. No statistically significant differences were observed between groups at the 1-year follow-up, and we could not deduce a common trend in favor of either intervention. At the 1-year follow-up, we found no difference between groups in terms of pain intensity and self-perceived change in chest pain in the first randomized clinical trial assessing chiropractic treatment vs minimal intervention for patients with acute musculoskeletal chest pain. Further research into health care utilization and use of prescriptive medication is warranted.Journal of manipulative and physiological therapeutics 05/2012; 35(4):254-62. · 1.06 Impact Factor -
Article: [(18) F]fluoromethylcholine (FCH) positron emission tomography/computed tomography (PET/CT) for lymph node staging of prostate cancer: a prospective study of 210 patients.
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ABSTRACT: Study Type - Diagnostic (exploratory cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Staging of patients with prostate cancer is the cornerstone of treatment. However, after curative intended therapy a high portion of patients relapse with local and/or distant recurrence. Therefore, one may question whether surgical lymph node dissection (LND) is sufficiently reliable for staging of these patients. Several imaging methods for primary LN staging of patients with prostate cancer have been tested. Acceptable detection rates have not been achieved by CT or MRI or for that matter with PET/CT using the most common tracer fluoromethylcholine (FCH). Other more recent metabolic tracers like acetate and choline seem to be more sensitive for assessment of LNs in both primary staging and re-staging. However, previous studies were small. Therefore, we assessed the value of [(18) F]FCH PET/CT for primary LN staging in a prospective study of a larger sample and with a 'blinded' review. After a study period of 3 years and >200 included patients, we concluded that [(18) F]FCH PET/CT did not reach an optimal detection rate compared with LND, and, therefore, it cannot replace this procedure. However, we did detect several bone metastases with [(18) F]FCH PET/CT that the normal bone scans had missed, and this might be worth pursuing. OBJECTIVES: • To assess the value of [(18) F]fluoromethylcholine (FCH) positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging of prostate cancer. • To evaluate if FCH PET/CT can replace LN dissection (LND) for LN staging of prostate cancer, as about one-third of patients with prostate cancer who receive intended curative therapy will have recurrence, one reason being undetected LN involvement. PATIENTS AND METHODS: • From January 2008 to December 2010, 210 intermediate- or high-risk patients had a FCH PET/CT scan before regional LND. • After dissection, the result of histological examination of the LNs (gold standard) was compared with the result of FCH PET/CT obtained by 'blinded review'. • Sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of FCH PET/CT were measured for detection of LNe metastases. RESULTS: • Of the 210 patients, 76 (36.2%) were in the intermediate-risk group and 134 (63.8%) were in the high-risk group. A medium (range) of 5 (1-28) LNs were removed per patient. • Histological examination of removed LNs showed metastases in 41 patients. Sensitivity, specificity, PPV, and NPV of FCH PET/CT for patient-based LN staging were 73.2%, 87.6%, 58.8% and 93.1%, respectively. • Corresponding values for LN-based analyses were 56.2%, 94.0%, 40.2%, and 96.8%, respectively. • The mean diameter of the true positive LN metastases was significantly larger than that of the false negative LNs (10.3 vs 4.6 mm; P < 0.001). • In addition, FCH PET/CT detected a high focal bone uptake, consistent with bone metastases, in 18 patients, 12 of which had histologically benign LNs. CONCLUSIONS: • Due to a relatively low sensitivity and a correspondingly rather low PPV, FCH PET/CT is not ideal for primary LN staging in patients with prostate cancer. • However, FCH PET/CT does convey important additional information otherwise not recognised, especially for bone metastases.BJU International 04/2012; · 2.84 Impact Factor -
Article: Reconstruction of the decision-making process in assessing musculoskeletal chest pain: an exploratory study using recursive partitioning.
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ABSTRACT: The purposes of this study were to identify the most important determinants from the patient history and clinical examination in diagnosing musculoskeletal chest pain (MSCP) in patients with acute noncardiac chest pain when supported by a structured protocol and to construct a decision tree for identification of MSCP in acute noncardiac chest pain. Consecutive patients with noncardiac chest pain (n = 302) recruited from an emergency cardiology department were assessed. Using data from self-report questionnaires, interviews, and clinical assessment, patient characteristics were associated with the MSCP diagnosis, and the decision-making process of the clinician was reconstructed using recursive procedures in the tradition of constructing Classification and Regression Trees. Thirty-eight percent of patients had MSCP. There was no single determinant that predicted the condition completely. However, many items with high associations could be identified, mainly with high negative predictive value. The decision-making process was reconstructed giving rise to a 5-step, linear decision tree without branches. Clinicians use a combination of indicators including systematic palpation of the spine and chest wall and items from the case history to diagnose MSCP. However, the high negative predictive values of the main determinants suggest that the MSCP diagnosis may be a diagnosis by exclusion.Journal of manipulative and physiological therapeutics 02/2012; 35(3):184-95. · 1.06 Impact Factor -
Article: Chiropractic treatment vs self-management in patients with acute chest pain: a randomized controlled trial of patients without acute coronary syndrome.
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ABSTRACT: The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2) self-management as an example of minimal intervention. In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to 4 weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up 4 and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale). Both groups experienced decreases in pain, self-perceived positive changes, and increases in Medical Outcomes Study Short Form 36-Item Health Survey scores. Observed between-group significant differences were in favor of chiropractic treatment at 4 weeks regarding the primary outcome of self-perceived change in chest pain and at 12 weeks with respect to the primary outcome of numeric change in pain intensity. To the best of our knowledge, this is the first randomized trial assessing chiropractic treatment vs minimal intervention in patients without acute coronary syndrome but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful; but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients is needed.Journal of manipulative and physiological therapeutics 12/2011; 35(1):7-17. · 1.06 Impact Factor -
Article: Feasibility of FDG-PET/CT imaging during concurrent chemo-radiotherapy in patients with locally advanced pancreatic cancer.
Acta oncologica (Stockholm, Sweden) 05/2011; 50(8):1250-2. · 2.27 Impact Factor -
Article: Discrepancy between coronary artery calcium score and HeartScore in middle-aged Danes: the DanRisk study.
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ABSTRACT: Coronary artery calcification (CAC) is an independent and incremental risk marker. This marker has previously not been compared to the HeartScore risk model. A random sample of 1825 citizens (men and women, 50 or 60 years of age) was invited for screening. Using the HeartScore model, the 10-year risk of fatal cardiovascular events based on gender, age, smoking, systolic blood pressure, and total cholesterol was estimated. A low risk was defined as <5%. The CAC score was calculated from a non-contrast enhanced cardiac-CT scan and given in Agatston U. A total of 1257 (69%) of the invited subjects were interested in the screening. Due to previous cardiovascular disease or diabetes mellitus, 101 were excluded. Of the remaining 1156, 47% were men and 53% women; one half were 50 years old and the other half 60 years old. A low HeartScore was found in 901 of which 334 (37%) had CAC. A high HeartScore was recorded in 251 of which 80 (32%) did not have any CAC. High HeartScores and CAC were significantly more common in males than females. CAC is common in healthy middle-aged Danes with a low HeartScore, and, on the contrary, high-risk subjects very frequently do not have CAC. The therapeutic and prognostic implications of these observations remain to be clarified.European journal of preventive cardiology. 04/2011; 19(3):558-64. -
Article: Patients' views of cardiac computed tomography angiography compared with conventional coronary angiography.
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ABSTRACT: Coronary computed tomography angiography (CTA) has proven to be useful for noninvasive examination in patients with intermediate risk of coronary artery disease. However, data addressing patients' views of this relatively new diagnostic modality are sparse. For comparison of CTA and invasive coronary angiography (CA), a total of 127 patients referred for CA for the suspicion of coronary artery disease were included in the study. Three months later the patients received a simple structured questionnaire addressing their views and preferences with regard to CTA versus CA. A total of 122 of 127 patients agreed to participate in the study. Pain or bleeding at the puncture site the day after the procedure was significantly more prevalent after CA than CTA (pain, 53% vs 2%; bleeding, 75% vs 22%). More patients had to stay home from work after CA for at least 1 day, even when excluding patients who had an ad hoc percutaneous coronary intervention: 44 of 95 (46%) versus 0 of 95 (0%). In general, 85% of the patients preferred CTA, and of the patients who underwent ad hoc percutaneous coronary intervention, 59% would choose CTA as the initial diagnostic procedure. The large majority of patients preferred CTA over conventional CA. This choice was most likely the result of less physical discomfort, fewer minor bleeding complications, and a higher rate of early return to work after CTA when compared with CA.Journal of thoracic imaging 03/2011; 27(1):36-9. · 1.42 Impact Factor -
Article: [18F]-fluorocholine positron-emission/computed tomography for lymph node staging of patients with prostate cancer: preliminary results of a prospective study.
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ABSTRACT: To evaluate prospectively [(18)F]-fluorocholine positron-emission/computed tomography (FCH PET/CT) for lymph node staging of prostate cancer before intended curative therapy, and to determine whether imaging 15 or 60 min after radiotracer injection is preferable. In all, 25 consecutive patients with newly diagnosed prostate cancer (Gleason score >6, and/or a prostate-specific antigen level of >10 ng/mL, and/or T3 cancer) were scanned before lymphadenectomy. Each patient was assessed twice with imaging, at 15 and 60 min after the injection with FCH. Images were compared with the results of histopathological examination of the surgically removed lymph nodes. Maximum standardized uptake values (SUV(max) ) at 15 and 60 min were also compared. Histopathologically, metastases were present in removed lymph nodes from three patients. FCH PET/CT showed a high radiotracer uptake in four patients, the former three and a fourth. The sensitivity, specificity, positive and negative predictive value of FCH PET/CT for patient based lymph node staging of prostate cancer were 100%, 95%, 75% and 100%, respectively; the corresponding 95% confidence intervals were 29.2-100%, 77.2-99.9%, 19.4-99.4% and 83.9-100%, respectively. Values of SUV(max) at early and late imaging were not significantly different. This small series supports the use of FCH PET/CT as a tool for lymph node staging of patients with prostate cancer. Values of SUV(max) at early and late imaging did not differ. However, larger prospective studies are needed to validate these findings.BJU International 09/2010; 106(5):639-43; discussion 644. · 2.84 Impact Factor -
Article: Muscular tenderness in the anterior chest wall in patients with stable angina pectoris is associated with normal myocardial perfusion.
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ABSTRACT: This study examines the relationship between the existence of chest wall tenderness evoked by palpation and the absence of ischemic heart disease defined by myocardial perfusion imaging in patients with known or suspected stable angina pectoris. Two hundred seventy-five patients were recruited. Myocardial perfusion imaging was performed on 273 of the subjects. Chest pain was classified according to type by criteria given by the Danish Society of Cardiology and severity by the Canadian Cardiovascular Society. Pectoralis major and pectoralis minor were palpated for tenderness using a standardized procedure. The association between tenderness and myocardial perfusion imaging (normal vs abnormal) produced an odds ratio (OR) of 2.24 (confidence interval, 1.26-3.99; P = .009). The OR was the same magnitude and significance when stratified by sex, age, type of pain, or class. When adjusting simultaneously for sex, age, type of pain, and class, the association between tenderness and myocardial perfusion imaging (normal vs abnormal) was still present (OR = 2.57; confidence interval, 1.342-4.902; P = .004). Presence of tenderness in the anterior chest wall is associated with a higher prevalence of normal myocardial perfusion imaging in patients with known or suspected angina pectoris, and this association cannot be explained by a common association to age, sex, or pain.Journal of manipulative and physiological therapeutics 07/2008; 31(5):344-7. · 1.06 Impact Factor -
Article: How well does standard clinician evaluation identify low likelihood of ischaemic or coronary heart disease?
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ABSTRACT: Guidelines claim that patients with a low likelihood of coronary artery disease can be reliably identified clinically by a simple set of rules. Among 385 patients referred for coronary angiography because of suspected stable angina pectoris we found by myocardial perfusion scintigraphy in three selected low likelihood groups reversible perfusion defects in 23%-29% of male and 11%-17% of female patients. Rates of significant angiographic disease were similar. These data question the validity of current clinical practice for identifying low likelihood of disease in this category of patients.International journal of cardiology 02/2008; 123(2):177-9. · 7.08 Impact Factor -
Article: Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy.
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ABSTRACT: We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary artery participated. The surgeon filled in a questionnaire pertaining to the planned localization and number of grafts. These estimates were compared to procedures actually performed and with the angiographic outcome six months after bypass surgery. Planned and actually inserted grafts disclosed a discrepancy in 22% of the patients, resulting in a lower or higher number of grafts than pre-operatively estimated. The difference in shift rates between the three sites, left anterior descending, left circumflex, and right coronary artery, was significant (P=0.014). Patency rates were highest when only preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional flow reserve as physiological adjuncts to angiography for more targeted revascularization.Interactive cardiovascular and thoracic surgery 07/2007; 6(3):298-302. -
Article: High probability of disease in angina pectoris patients: is clinical estimation reliable?
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ABSTRACT: According to most current guidelines, stable angina pectoris patients with a high probability of having coronary artery disease can be reliably identified clinically. To examine the reliability of clinical evaluation with or without an at-rest electrocardiogram (ECG) in patients with a high probability of coronary artery disease. A prospective series of 357 patients referred for coronary angiography (CA) for suspected stable angina pectoris were examined by a trained physician who judged their type of pain and Canadian Cardiovascular Society grade of pain. Pretest likelihood of disease was estimated, and all patients underwent myocardial perfusion scintigraphy (MPS) followed by CA an average of 78 days later. For analysis, the investigators focused on the approximate groups of patients with more severe disease, ie, typical angina (n=187), Canadian Cardiovascular Society grade 2 pain or higher (n=176) or high (higher than 85%) estimated pretest likelihood of disease (n=142). In the three groups, 34% to 39% of male patients and 65% to 69% of female patients had normal MPS, while 37% to 38% and 60% to 71%, respectively, had insignificant findings on CA. Of the patients who had also an abnormal at-rest ECG, 14% to 21% of men and 42% to 57% of women had normal MPS. Sex-related differences were statistically significant. Clinical prediction appears to be unreliable. Addition of at-rest ECG data results in some improvement, particularly in male patients, but it makes the high probability groups so small that the addition appears to be of limited clinical relevance.The Canadian journal of cardiology 07/2007; 23(8):641-7. · 3.36 Impact Factor -
Article: Prognostic value of myocardial perfusion imaging in patients with known or suspected stable angina pectoris: evaluation in a setting in which myocardial perfusion imaging did not influence the choice of treatment.
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ABSTRACT: Previous investigations on the prognostic value of myocardial perfusion imaging (MPI) were performed under circumstances in which the test result was known to the patient's physician. We wanted to examine the prognostic value of MPI in patients with known or suspected stable angina in a setting in which MPI could not influence the diagnostic and therapeutic strategy. A prospective series of 507 patients referred to coronary angiography for this condition were examined by MPI before angiography. Management was based on symptoms and angiographic findings, as the results of MPI were not communicated. Patients were followed for a mean of 45.3 +/- 7.7 months. During follow-up, 20 patients (3.9%) suffered from myocardial infarction, 19 (3.8%) died and eight (1.6%) were revascularized >1 year after MPI resulting in a combined annual event rate of 2.5%. Patients with normal MPI had a low annual event rate of 1.6% (or 1.1% with regard to myocardial infarction or death only). In contrast, event rates in patients with reversible or mixed ischaemia were 4.0% per year. MPI added independent prognostic value to standard clinical data in a multivariate Cox model. We could confirm that in patients with known or suspected stable angina, MPI is a valuable risk stratifying tool.Clinical physiology and functional imaging 10/2006; 26(5):288-95. · 1.21 Impact Factor -
Article: To what degree is amelioration of angina following coronary revascularization associated with improvement in myocardial perfusion?
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ABSTRACT: To examine the association between changes in chest pain and changes in perfusion following revascularization as assessed by clinical evaluation and myocardial perfusion imaging (MPI) in patients with stable angina. In a prospective series of 380 patients (58.8 +/- 8.8 years) referred to angiography because of known or suspected stable angina, changes in chest discomfort and changes in perfusion after 2 years were assessed in 144 patients, who underwent revascularization, and 236, who did not. The decision to treat invasively was made without knowledge of the result of MPI. In revascularized patients, the presence of typical/atypical angina was reduced from 93% to 36% and the improvement was associated with improvement in perfusion. A small improvement in perfusion induced a high frequency of change from angina to no pain, whereas a further reduction caused little extra change. In non-revascularized patients the change in chest discomfort was not related to changes in perfusion, which were rarely present. Alleviation of chest discomfort 2 years after revascularization is associated with improvements in perfusion. This association appeared to be an all-or-nothing phenomenon. Non-revascularized patients also exhibited improvements in chest discomfort despite insignificant changes in perfusion.Clinical physiology and functional imaging 10/2006; 26(5):263-70. · 1.21 Impact Factor -
Article: [Hepatocellular carcinoma and other liver tumors].
Ugeskrift for laeger 06/2006; 168(19):1876; author reply 1876. -
Article: [Quality improvement of referrals from practising physicians. An example of a practicable strategy].
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ABSTRACT: Referrals from practising physicians to hospital departments are of varying quality. This increases the risk of inappropriate or even incorrect patient treatment courses. We examined the quality of referrals to a large department of nuclear medicine before and after initiatives aimed at improving the information and feedback to the practising physicians. An evaluation of the quality of referrals (n = 579) from praticising physicians to the Department of Nuclear Medicine, Odense University Hospital, Denmark, recorded during two periods of three months each before and after (1) publication of a referral guideline and (2) a feedback response to those physicians whose referrals were insufficient. A general practitioner (GP) and a specialist in nuclear medicine (NM) judged independently whether the referrals were good, acceptable or unacceptable. During the two periods, 281 and 298 referrals were received, respectively. Of these, 37% and 27%, respectively, were from practising specialists (PSs). After intervention, 23% more referrals were received from GPs, and the share of "good" referrals also increased (before/after: 48%/72% (GP), 61%/84% (NM)). In contrast, there was a 23% decrease in referrals from PSs, whereas the share of "good" referrals remained unchanged or increased (before/after: 64%/66 % (GP), 64%/96% (NM)). In addition, there was a change in the referral pattern from both GPs and PSs. Relatively simple and inexpensive intervention caused an increase in the number and quality of referrals from GPs and a fall in referrals from PSs without an obvious improvement in quality.Ugeskrift for laeger 05/2006; 168(14):1434-8. -
Article: [Quality control of whole-body bone scintigraphy. Patient surveys].
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ABSTRACT: The quality of health care is but sparsely elucidated; surveys of complete patient courses hardly exist. We established and used benchmarks for a major nuclear medicine examination: whole-body bone scintigraphy. The study material included 458 out of 512 consecutive examinations. Patients were referred by general practitioners (12%), practising specialists (16%) and hospital departments (72%). The survey dealt with waiting times and information provided, as judged by the patient, the referring physician and the Department of Nuclear Medicine (DNM) in relation to referrals, reporting and the passing on of the results to the patient. The DNM judged the quality of the examinations, and the referring physician assessed the implications for diagnosis and treatment. In 10% of the cases, the patient felt that the waiting time was unsatisfactory, as the referring physician might take up to 150 days to send the referral and because 11% had, after two months, still not been informed of the examination result. Supplementary tomography was used in 38 examinations (8%); of these, only one (3%) provided new evidence. Based on the examination results, the referring physician could make a diagnosis and/or wanted to change management for 61% of patients. Referrals were delayed mainly by the referring physicians, who often forgot to inform their patients of the examination results. Special admissions seldom yielded extra information. The examination result had important clinical implications in almost two thirds of patients.Ugeskrift for laeger 05/2006; 168(14):1438-42. -
Article: Potential impact of myocardial perfusion scintigraphy as gatekeeper for invasive examination and treatment in patients with stable angina pectoris: observational study without post-test referral bias.
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ABSTRACT: To evaluate the impact of using myocardial perfusion scintigraphy (MPS) as gatekeeper for coronary angiography and revascularization in stable angina pectoris. A prospective series of 507 out of 972 adult patients referred to coronary angiography for known or suspected stable angina pectoris underwent clinical examination followed immediately by MPS, the result of which was not communicated. MPS showed normal perfusion in 258/507 (51%) patients, reversible defects in 201/507 (40%), and fixed defects in 48/507 (9%). Of 168 revascularized patients, 27 (16%) had normal perfusion and 13 (8%) had fixed defects. Coronary angiography was undertaken in 476 patients of whom 252 (53%) had normal findings or insignificant stenoses. The same was the case in 361 (41%) out of the 883 of the 972 consecutive patients, who had this examination. Assuming that the true rate of normal perfusion in the entire series was correspondingly lower, 48% of catheterizations and 19% of revascularizations were superfluous. The use of MPS as gatekeeper appears to make about half of catheterizations and almost one-fifth of revascularizations redundant. Even in high-risk groups, substantial savings are possible, and the risk of overlooking patients with severe disease seems negligible.European Heart Journal 02/2006; 27(1):29-34. · 10.48 Impact Factor -
Article: Assessment of left ventricular systolic function by the chest x-ray: comparison with radionuclide ventriculography.
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ABSTRACT: The value of the plain chest roentgenogram in predicting cardiac status remains controversial. A total of 111 randomly selected survivors of acute myocardial infarction (age 38 to 83 years) were studied prospectively. X-ray and radionuclide examinations were performed on a morning in the second week after myocardial infarction. From the chest x-ray, left ventricular chamber size and pulmonary vascular congestion were graded visually, and relative cardiac volume was measured to allow for comparison with radionuclide left ventricular end-diastolic volume index (LVEDVI) and left ventricular ejection fraction (LVEF) determined by gated blood pool imaging. Despite significant tendencies for larger radionuclide LVEDVI and lower LVEF with greater radiographic left ventricular size, larger relative cardiac volume, and increasing degrees of pulmonary congestion, wide scatter, and large overlaps between groups precluded reliable radiographic prediction of radionuclide findings. The positive and negative predictive values for radiographic detection of an enlarged LVEDVI ranged from 59% to 80% and 56% to 71%, respectively, and for prediction of a decreased LVEF from 75% to 90% and 40% to 58%, respectively. Accuracy never exceeded 70%. Our findings question the value of the chest roentgenogram in the detection and grading of left ventricular systolic dysfunction in patients with recent myocardial infarction.Journal of Cardiac Failure 06/2005; 11(4):299-305. · 3.66 Impact Factor
Top co-authors
Top Journals
Institutions
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2003–2013
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Odense University Hospital
- Department of Oncology
Odense, South Denmark, Denmark
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2006–2008
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University of Southern Denmark
Kolding, South Denmark, Denmark
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