Louise Nissen

Aims: Chronic kidney disease (CKD) and coronary artery disease (CAD) share common risk factors, but the association between kidney function [estimated glomerular filtration rate (eGFR) in mL/min/1.73 m²] and major adverse cardiovascular events (MACE) in patients undergoing coronary computed tomography angiography (CCTA) due to suspected CAD has not been established. This study investigated the association between kidney function and MACE in symptomatic patients undergoing CCTA. Methods and results: A cohort study of consecutive, symptomatic patients undergoing CCTA between 2008 and 2021 (n = 70 367). CAD severity was stratified as no CAD, non-obstructive CAD, and obstructive CAD (≥50% diameter stenosis). The primary outcome was MACE (myocardial infarction, ischaemic stroke, or cardiovascular death). eGFR was calculated based on plasma-creatinine at the time of CCTA. In total, 41 156 (59%) had eGFR ≥90, 27,011 (38%) had eGFR 60–89, and 2200 (3%) had eGFR 30–59. Median follow-ups were 5.1 years, according to eGFR ≥90, 60–89, and 30–59 groups, MACE rates per 1000 person-years in patients with obstructive CAD were 14.2, 15.4, and 25.8, respectively, and in patients with non-obstructive CAD the MACE rates were 6.4, 8.0, and 14.4, respectively. Compared to patients with eGFR ≥90, hazard ratios for MACE were 1.09 [95% confidence intervals (CI) 1.00–1.19] and 1.42 (95%CI 1.18–1.69) for patients with eGFR 60–89 and 30–59, respectively. Conclusion: In patients referred for CCTA due to suspected CAD, reduced kidney function was associated with an increased rate of MACE. Therefore, CKD is a strong independent cardiovascular risk factor, particularly in patients with CAD detected on CCTA.

While psychiatric treatment mostly focuses on mental health, comorbid somatic conditions are frequent and often undertreated. This study aimed to bridge the gap by assessing the feasibility of medical consultations for psychiatric inpatients and to identify somatic and lifestyle-related conditions, as well as abnormal paraclinical findings. Secondly, we aimed to identify psychiatric treatments and diagnoses associated with metabolic outcomes. Patients admitted to Department of Psychiatry Vejle, Denmark, between October 2022 and December 2023 were invited to participate in a medical consultation. The consultations gathered data on comorbidities and lifestyle, including smoking habits, alcohol and drug use, and body metrics. Additionally, information on medical treatment and biochemical markers was collected. A total of 238 patients were enrolled [mean age 48.2 ± 18.6 years; 50.8% were men]. Health assessment revealed that 111 (46.6%) were active smokers and 129 (54.2%) had a body mass index (BMI) of ≥ 25 kg/m². Biochemical analysis showed that 78 (32.8%) had vitamin D levels below 50 nmol/L and 89 (38%) had a low-density lipoprotein level >3 mmol/L. Patients treated with two or more antipsychotic drugs had a significantly higher BMI (4.6 kg/m², 95% CI: 0.8-8.3) compared with individuals not taking antipsychotic medication. The study demonstrates that medical consultations for hospitalized psychiatric patients are feasible and important, revealing abnormal biochemical markers and significant somatic comorbidities and lifestyle-related conditions. These findings suggest that routine medical assessments could enhance patient treatment and care and guide targeted interventions for metabolic and somatic health issues in psychiatric settings.

Purpose: Myocardial perfusion imaging (MPI) procedures from single photon emission computed tomography and positron emission tomography imaging have been registered in the Western Denmark Heart Registry (WDHR) since 2017 as a sub-registry (WDHR-MPI). The aim was to review the content, quality, and research potential of the WDHR-MPI and assess the completeness and validity of its key variables. Patients and Methods: Using the Danish National Patient Registry (DNPR) as a reference, we calculated the completeness of procedure registration as the proportion of procedures registered in the WDHR-MPI from 2017 to 2021. We defined completeness of variable registration as the proportion of non-missing values for a given variable and examined it for 38 key variables. We assessed validity by estimating the positive predictive values (PPV) and negative predictive values (NPV) with 95% confidence intervals (CI) for 26 selected key variables using corresponding extracted information from 300 randomly selected patient records. Results: We identified 19,084 procedures in 17,871 patients from all seven cardiac centers performing nuclear cardiology procedures in the WDHR uptake area. The registry accumulated 4000– 6000 procedures each year from 2019 to 2021. The overall completeness of procedure registration was 72% (95% CI 72– 73), increasing from 14% (95% CI 13– 15) in 2017 to 98% (95% CI 98– 98) in 2021. The mean completeness of variable registration was 89%. The validity of entered data was high, with an overall PPV for the selected key variables of 95% (95% CI 94– 95) and NPV of 94% (95% CI 93– 96). Conclusion: The WDHR-MPI is one of the largest systematic MPI cohorts. The overall high completeness and validity of the data support its potential for cardio-epidemiological research. Plain Language Summary: If you have ischemic heart disease, you may experience symptoms such as chest tightness and shortness of breath due to decreased blood supply to the heart muscle. To help identify decreased blood supply to the heart muscle, doctors can use a specialized scan which involves the injection of low doses of radioactive tracers into the bloodstream. Since 2017, doctors in Denmark have been recording these scans in the Western Denmark Myocardial Perfusion Imaging Registry (WDHR-MPI). This study found a high completeness and validity of the registry. With 19,084 scans recorded from 2017 to 2021, this registry provides a high-quality resource that could improve diagnosis and treatment for people with heart disease.

Most patients undergoing coronary computed tomography angiography (CCTA) to diagnose coronary artery disease (CAD) are referred from general practitioners (GPs). The burden of contacts to GP in relation to investigation of suspected CAD is unknown. All patients undergoing CCTA in Western Denmark from 2014 to 2022 were included. CCTA stenosis was defined as diameter stenosis of ≥50%. Patients with and without stenosis were matched, in each group, 1:5 to a reference population based on birth year, gender, and municipality using data from national registries. All GP visits were registered up to 5 years preceding and 1 year after the CTA and stratified by gender and age. Charlson comorbidity index (CCI) was calculated in all groups. Of the 62 512 patients included, 12 886 had a stenosis, while 49 626 did not. Patients in both groups had a substantially higher GP visit frequency compared with reference populations. In the year of coronary CTA, the median GP contacts in patients with stenosis were 11 (6–17) vs. 6 (2–11) in the reference population (P < 0.001), and in patients without stenosis, the median GP contacts were 10 (6–17) vs. 5 (2–11) (P < 0.001). These findings were consistent across age and gender. CCI was higher among both patients with and without stenosis compared with reference groups. In patients undergoing CCTA to diagnose CAD, a substantially increased frequency of contacts to GP was observed in the 5-year period prior to examination compared with the reference populations, regardless of the CCTA findings. Obtaining the CCTA result did not seem to substantially affect the GP visit frequency. Patients undergoing coronary CTA due to symptoms suggestive of chronic coronary syndrome have an increased use visits to general practitioners in a 5 year period prior to examination, compared to a reference population.

Objectives: To assess the feasibility of extracting radiomics signal intensity based features from the myocardium using cardiovascular magnetic resonance (CMR) imaging stress perfusion sequences. Furthermore, to compare the diagnostic performance of radiomics models against standard-of-care qualitative visual assessment of stress perfusion images, with the ground truth stenosis label being defined by invasive Fractional Flow Reserve (FFR) and quantitative coronary angiography.Methods: We used the Dan-NICAD 1 dataset, a multi-centre study with coronary computed tomography angiography, 1,5 T CMR stress perfusion, and invasive FFR available for a subset of 148 patients with suspected coronary artery disease. Image segmentation was performed by two independent readers. We used the Pyradiomics platform to extract radiomics first-order (n = 14) and texture (n = 75) features from the LV myocardium (basal, mid, apical) in rest and stress perfusion images.Results: Overall, 92 patients (mean age 62 years, 56 men) were included in the study, 39 with positive FFR. We double-cross validated the model and, in each inner fold, we trained and validated a per territory model. The conventional analysis results reported sensitivity of 41% and specificity of 84%. Our final radiomics model demonstrated an improvement on these results with an average sensitivity of 53% and specificity of 86%.Conclusion: In this proof-of-concept study from the Dan-NICAD dataset, we demonstrate the feasibility of radiomics analysis applied to CMR perfusion images with a suggestion of superior diagnostic performance of radiomics models over conventional visual analysis of perfusion images in picking up perfusion defects defined by invasive coronary angiography.

Aims: Clinical likelihood (CL) models are designed based on a reference of coronary stenosis in patients with suspected obstructive coronary artery disease. However, a reference standard for myocardial perfusion defects (MPDs) could be more appropriate. We aimed to investigate the ability of the 2019 European Society of Cardiology pre-test probability (ESC-PTP), the risk-factor-weighted (RF-CL) model, and coronary artery calcium score-weighted (CACS-CL) model to diagnose MPDs. Methods and results: Symptomatic stable de novo chest pain patients (n = 3374) underwent coronary computed tomography angiography and subsequent myocardial perfusion imaging by single-photon emission computed tomography, positron emission tomography, or cardiac magnetic resonance. For all modalities, MPD was defined as coronary computed tomography angiography with suspected stenosis and stress-perfusion abnormality in ≥2 segments. The ESC-PTP was calculated based on age, sex, and symptom typicality, and the RF-CL and CACS-CL additionally included a number of risk factors and CACS. In total, 219/3374 (6.5%) patients had an MPD. Both the RF-CL and the CACS-CL classified substantially more patients to low CL (<5%) of obstructive coronary artery disease compared with the ESC-PTP (32.5 and 54.1 vs. 12.0%, P < 0.001) with preserved low prevalences of MPD (<2% for all models). Compared with the ESC-PTP [area under the receiver-operating characteristic curve (AUC) 0.74 (0.71–0.78)], the discrimination of having an MPD was higher for the CACS-CL model [AUC 0.88 (0.86–0.91), P < 0.001], while it was similar for the RF-CL model [AUC 0.73 (0.70–0.76), P = 0.32]. Conclusion: Compared with basic CL models, the RF-CL and CACS-CL models improve down classification of patients to a very low-risk group with a low prevalence of MPD.