AimsValvular event timing is an integral part of echocardiographic pressure–strain loop (PSL) ana... more AimsValvular event timing is an integral part of echocardiographic pressure–strain loop (PSL) analyses. The impact that different event timing modalities may have on myocardial work indices is unknown.Methods and resultsA methodological study was performed on 200 subjects, including 50 healthy subjects, 50 with aortic valve sclerosis, 50 with atrial fibrillation, and 50 with reduced left ventricular ejection fraction. Valvular event timing was estimated by visual assessment, spectral Doppler, and colour tissue Doppler imaging (TDI) M-mode. These valvular event timings were added to the same PSL analyses sequentially to acquire myocardial work indices, including global work index (GWI). For the 200 participants, the median age was 72 years, 50% were men, and mean blood pressure was 143/80 mmHg. Valvular event timings differed between all three modalities and so did all myocardial work indices. Compared with visual assessment, spectral Doppler resulted in a significantly higher GWI (m...
IntroductionDespite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexp... more IntroductionDespite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexplained. Paroxysmal atrial fibrillation is typically suspected but often not detected. Even if atrial fibrillation (AF) is detected, the quantitative threshold of clinically relevant AF remains unclear. Emerging evidence suggests that left atrial (LA) functional and structural abnormalities may convey a risk of ischaemic stroke in which AF is only one of several features. These abnormalities have been termed ‘atrial cardiomyopathy’. This study uses cardiac magnetic resonance (CMR) to evaluate atrial cardiomyopathy among patients with stroke of undetermined aetiology compared with those with an attributable mechanism and controls without established cardiovascular disease.Methods and analysisThis cross-sectional and prospective cohort study included 100 patients with recent ischaemic stroke and 50 controls with no established cardiovascular disease. The study will assess LA structural and ...
Background: In current literature, left atrial (LA) function assessed by 2D speckle tracking echo... more Background: In current literature, left atrial (LA) function assessed by 2D speckle tracking echocardiography (2DSTE) has shown increasing clinical and prognostic significance. We sought to establish age- and sex-based normative values of LA strain measures in the general population and to assess the diagnostic and prognostic yield of the prediction intervals (PI) in relation to baseline and future atrial fibrillation (AF). Methods: We performed 2DSTE in members of the general population included in the 5 th round of the Copenhagen City Heart Study. We determined normative values of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and left atrial conduit strain (LACS) based on age and sex in 1,757 healthy participants. In a secondary analysis, 3,657 participants, regardless of health status, were included to assess the diagnostic and prognostic value of the established reference values. Results: In the healthy cohort, median age was 46 years (IQR: 33, 5...
Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in ... more Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a base...
The International Journal of Cardiovascular Imaging, 2010
This study used multi-detector row CT (MDCT) to evaluate the regional geometric parameters of lef... more This study used multi-detector row CT (MDCT) to evaluate the regional geometric parameters of left ventricle (LV) in patients and dogs after right ventricular apical (RVA) pacing. First, we measured and compared the global and regional wall motion parameters derived from MDCT images between three patients post RVA pacing and seven age-matched healthy subjects. The LV ejection fraction (LVEF), LV end-diastolic volume and LV end-systolic volume were measured. We also measured the regional wall thickness, wall thickening and regional wall motion in 12 different segments of the LV. Second, we performed MDCT scan on five dogs as the study group (pacing wire + RVA pacing, 2 months) and four dogs as the sham control group (pacing wire, 2 months). The global and regional geometric parameters were compared within both human and canine groups. Compared with normal subjects, patients post RVA pacing had low LVEF (60.4 ± 10.5 vs. 33.2 ± 17.6, P = 0.014), impaired regional wall thickening and regional wall motion, particularly in segments near the pacing lead. Some segments near the pacing lead were showing dyskinesia after pacing. These findings were successfully reproduced in the canine model. We found that RVA pacing can result in impaired regional wall thickening and regional wall motion, particularly in segments near the pacing lead.
During a five year observation period, declines of forced vital capacity (FVC) and forced expirat... more During a five year observation period, declines of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were investigated in 200 subjects with diabetes mellitus (DM), 126 subjects who developed DM during that period and 9,051 nondiabetic subjects. After statistical adjustment for age, sex, height, and tobacco consumption we found that the subjects who developed DM during the observation period had the steepest declines of ventilatory function. Their annual declines of FVC (and FEV1) were on average 29 ml (and 25 ml) greater than the declines observed among the nondiabetic subjects. The subjects who had DM during the whole observation period experienced a decline of ventilatory function which was not significantly greater than the decline among the nondiabetic subjects. Our results suggest that DM, at its onset, is associated with a significantly accelerated decline of ventilatory function. If DM has been present for some years, its impact on the decline of v...
Objectives To investigate the agreement between two-dimensional (2DE) and three-dimensional echoc... more Objectives To investigate the agreement between two-dimensional (2DE) and three-dimensional echocardiography (3DE) in a general population, along with clinical impact of the differences. Background Left ventricular ejection fraction (LVEF) has prognostic value and is used to guide cardiac treatment. The preferred technique is two-dimensional (2D) echo, although three-dimensional (3D) echo is more accurate when compared to MRI. Our study evaluates the agreement between 2D and 3D LVEF and the potential clinical impact of disagreements. Methods Study population ware participants from the Copenhagen City Heart Study, who underwent 2DE and 3DE between 2011–2014. Means of difference (MD) were assessed in participant groups with a LVEF below 40%, 40–50%, and above 50%. Age-adjusted Cox proportional hazard ratios (HR) were calculated for all-cause mortality, major adverse cardiovascular event (MACE) and cardiac event of any kind. Results In total 2554 participants from the Copenhagen City H...
Objective Prolonged seated immobility during long-distance flights is related to an increased ris... more Objective Prolonged seated immobility during long-distance flights is related to an increased risk of venous thromboembolism (VTE) but little is known on the risk, if any, related to sedentary work. The objective of this paper was to examine the risk of VTE according to sitting posture at work. Methods A total of 88 077 participants from the Copenhagen City Heart Study and the Copenhagen General Population Study were included in the study cohort, all without previous thromboembolic events and aged below 65 years. Activity level at work was obtained at baseline through self-administered questionnaires. VTEs were identified through national patient registries with complete coverage. Survival analyses were performed to determine the risk of VTE according to activity level at work with adjustment for a range of known determinants including lifestyle and coagulation factors. Results During the follow-up period of 5 79 116 person years (mean follow-up, 7 years) 805 participants experience...
European Heart Journal - Cardiovascular Imaging, 2021
Aims Left atrial (LA) function assessed by two-dimensional speckle-tracking echocardiography has... more Aims Left atrial (LA) function assessed by two-dimensional speckle-tracking echocardiography has shown increasing clinical and prognostic significance. We sought to establish age- and sex-based normative values of LA strain in the general population and to assess the prognostic yield of lower limits of normality of LA strain in relation to future atrial fibrillation (AF). Methods and results We determined normative values of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase (LACS) in 1641 healthy participants included in the fifth Copenhagen City Heart Study. In a secondary analysis, a validation cohort of 2016 participants, regardless of health status, were included to assess the prognostic value of the established reference values. In the healthy cohort, median age was 46 years (interquartile range 32–57), 62% were female. Median PALS, PACS, and LACS and corresponding limits of normality in the healthy participa...
European Heart Journal - Cardiovascular Imaging, 2021
Background Left atrial (LA) strain parameters have been demonstrated to be valuable predictors of... more Background Left atrial (LA) strain parameters have been demonstrated to be valuable predictors of atrial fibrillation (AF) in several patient cohorts. The purpose of this study was to investigate whether LA strain, assessed by two-dimensional speckle-tracking echocardiography, can be used to predict the development of AF in the general population. Methods and results This prospective longitudinal study included 4466 participants from the fifth Copenhagen City Heart Study. All participants underwent a health examination, including echocardiographic measurements of LA strain. Participants with prevalent AF at baseline were excluded. The primary endpoint was incident AF. During a median follow-up period of 5.3 years, 154 (4.3%) participants developed AF. In univariable analysis, peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase were significantly associated with the development of AF. PALS [hazard ratio (HR) 1.05, 95% ...
AimsThe degree of cardiovascular sequelae following COVID‐19 remains unknown. The aim of this stu... more AimsThe degree of cardiovascular sequelae following COVID‐19 remains unknown. The aim of this study was to investigate whether cardiac function recovers following COVID‐19.Methods and resultsA consecutive sample of patients hospitalized with COVID‐19 was prospectively included in this longitudinal study. All patients underwent an echocardiographic examination during hospitalization and 2 months later. All participants were successfully matched 1:1 with COVID‐19‐free controls by age and sex. A total of 91 patients were included (mean age 63 ± 12 years, 59% male). A median of 77 days (interquartile range: 72–92) passed between the two examinations. Right ventricular (RV) function improved following resolution of COVID‐19: tricuspid annular plane systolic excursion (TAPSE) (2.28 ± 0.40 cm vs. 2.11 ± 0.38 cm, P < 0.001) and RV longitudinal strain (RVLS) (25.3 ± 5.5% vs. 19.9 ± 5.8%, P < 0.001). In contrast, left ventricular (LV) systolic function assessed by global longitudinal st...
AimsValvular event timing is an integral part of echocardiographic pressure–strain loop (PSL) ana... more AimsValvular event timing is an integral part of echocardiographic pressure–strain loop (PSL) analyses. The impact that different event timing modalities may have on myocardial work indices is unknown.Methods and resultsA methodological study was performed on 200 subjects, including 50 healthy subjects, 50 with aortic valve sclerosis, 50 with atrial fibrillation, and 50 with reduced left ventricular ejection fraction. Valvular event timing was estimated by visual assessment, spectral Doppler, and colour tissue Doppler imaging (TDI) M-mode. These valvular event timings were added to the same PSL analyses sequentially to acquire myocardial work indices, including global work index (GWI). For the 200 participants, the median age was 72 years, 50% were men, and mean blood pressure was 143/80 mmHg. Valvular event timings differed between all three modalities and so did all myocardial work indices. Compared with visual assessment, spectral Doppler resulted in a significantly higher GWI (m...
IntroductionDespite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexp... more IntroductionDespite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexplained. Paroxysmal atrial fibrillation is typically suspected but often not detected. Even if atrial fibrillation (AF) is detected, the quantitative threshold of clinically relevant AF remains unclear. Emerging evidence suggests that left atrial (LA) functional and structural abnormalities may convey a risk of ischaemic stroke in which AF is only one of several features. These abnormalities have been termed ‘atrial cardiomyopathy’. This study uses cardiac magnetic resonance (CMR) to evaluate atrial cardiomyopathy among patients with stroke of undetermined aetiology compared with those with an attributable mechanism and controls without established cardiovascular disease.Methods and analysisThis cross-sectional and prospective cohort study included 100 patients with recent ischaemic stroke and 50 controls with no established cardiovascular disease. The study will assess LA structural and ...
Background: In current literature, left atrial (LA) function assessed by 2D speckle tracking echo... more Background: In current literature, left atrial (LA) function assessed by 2D speckle tracking echocardiography (2DSTE) has shown increasing clinical and prognostic significance. We sought to establish age- and sex-based normative values of LA strain measures in the general population and to assess the diagnostic and prognostic yield of the prediction intervals (PI) in relation to baseline and future atrial fibrillation (AF). Methods: We performed 2DSTE in members of the general population included in the 5 th round of the Copenhagen City Heart Study. We determined normative values of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and left atrial conduit strain (LACS) based on age and sex in 1,757 healthy participants. In a secondary analysis, 3,657 participants, regardless of health status, were included to assess the diagnostic and prognostic value of the established reference values. Results: In the healthy cohort, median age was 46 years (IQR: 33, 5...
Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in ... more Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a base...
The International Journal of Cardiovascular Imaging, 2010
This study used multi-detector row CT (MDCT) to evaluate the regional geometric parameters of lef... more This study used multi-detector row CT (MDCT) to evaluate the regional geometric parameters of left ventricle (LV) in patients and dogs after right ventricular apical (RVA) pacing. First, we measured and compared the global and regional wall motion parameters derived from MDCT images between three patients post RVA pacing and seven age-matched healthy subjects. The LV ejection fraction (LVEF), LV end-diastolic volume and LV end-systolic volume were measured. We also measured the regional wall thickness, wall thickening and regional wall motion in 12 different segments of the LV. Second, we performed MDCT scan on five dogs as the study group (pacing wire + RVA pacing, 2 months) and four dogs as the sham control group (pacing wire, 2 months). The global and regional geometric parameters were compared within both human and canine groups. Compared with normal subjects, patients post RVA pacing had low LVEF (60.4 ± 10.5 vs. 33.2 ± 17.6, P = 0.014), impaired regional wall thickening and regional wall motion, particularly in segments near the pacing lead. Some segments near the pacing lead were showing dyskinesia after pacing. These findings were successfully reproduced in the canine model. We found that RVA pacing can result in impaired regional wall thickening and regional wall motion, particularly in segments near the pacing lead.
During a five year observation period, declines of forced vital capacity (FVC) and forced expirat... more During a five year observation period, declines of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were investigated in 200 subjects with diabetes mellitus (DM), 126 subjects who developed DM during that period and 9,051 nondiabetic subjects. After statistical adjustment for age, sex, height, and tobacco consumption we found that the subjects who developed DM during the observation period had the steepest declines of ventilatory function. Their annual declines of FVC (and FEV1) were on average 29 ml (and 25 ml) greater than the declines observed among the nondiabetic subjects. The subjects who had DM during the whole observation period experienced a decline of ventilatory function which was not significantly greater than the decline among the nondiabetic subjects. Our results suggest that DM, at its onset, is associated with a significantly accelerated decline of ventilatory function. If DM has been present for some years, its impact on the decline of v...
Objectives To investigate the agreement between two-dimensional (2DE) and three-dimensional echoc... more Objectives To investigate the agreement between two-dimensional (2DE) and three-dimensional echocardiography (3DE) in a general population, along with clinical impact of the differences. Background Left ventricular ejection fraction (LVEF) has prognostic value and is used to guide cardiac treatment. The preferred technique is two-dimensional (2D) echo, although three-dimensional (3D) echo is more accurate when compared to MRI. Our study evaluates the agreement between 2D and 3D LVEF and the potential clinical impact of disagreements. Methods Study population ware participants from the Copenhagen City Heart Study, who underwent 2DE and 3DE between 2011–2014. Means of difference (MD) were assessed in participant groups with a LVEF below 40%, 40–50%, and above 50%. Age-adjusted Cox proportional hazard ratios (HR) were calculated for all-cause mortality, major adverse cardiovascular event (MACE) and cardiac event of any kind. Results In total 2554 participants from the Copenhagen City H...
Objective Prolonged seated immobility during long-distance flights is related to an increased ris... more Objective Prolonged seated immobility during long-distance flights is related to an increased risk of venous thromboembolism (VTE) but little is known on the risk, if any, related to sedentary work. The objective of this paper was to examine the risk of VTE according to sitting posture at work. Methods A total of 88 077 participants from the Copenhagen City Heart Study and the Copenhagen General Population Study were included in the study cohort, all without previous thromboembolic events and aged below 65 years. Activity level at work was obtained at baseline through self-administered questionnaires. VTEs were identified through national patient registries with complete coverage. Survival analyses were performed to determine the risk of VTE according to activity level at work with adjustment for a range of known determinants including lifestyle and coagulation factors. Results During the follow-up period of 5 79 116 person years (mean follow-up, 7 years) 805 participants experience...
European Heart Journal - Cardiovascular Imaging, 2021
Aims Left atrial (LA) function assessed by two-dimensional speckle-tracking echocardiography has... more Aims Left atrial (LA) function assessed by two-dimensional speckle-tracking echocardiography has shown increasing clinical and prognostic significance. We sought to establish age- and sex-based normative values of LA strain in the general population and to assess the prognostic yield of lower limits of normality of LA strain in relation to future atrial fibrillation (AF). Methods and results We determined normative values of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase (LACS) in 1641 healthy participants included in the fifth Copenhagen City Heart Study. In a secondary analysis, a validation cohort of 2016 participants, regardless of health status, were included to assess the prognostic value of the established reference values. In the healthy cohort, median age was 46 years (interquartile range 32–57), 62% were female. Median PALS, PACS, and LACS and corresponding limits of normality in the healthy participa...
European Heart Journal - Cardiovascular Imaging, 2021
Background Left atrial (LA) strain parameters have been demonstrated to be valuable predictors of... more Background Left atrial (LA) strain parameters have been demonstrated to be valuable predictors of atrial fibrillation (AF) in several patient cohorts. The purpose of this study was to investigate whether LA strain, assessed by two-dimensional speckle-tracking echocardiography, can be used to predict the development of AF in the general population. Methods and results This prospective longitudinal study included 4466 participants from the fifth Copenhagen City Heart Study. All participants underwent a health examination, including echocardiographic measurements of LA strain. Participants with prevalent AF at baseline were excluded. The primary endpoint was incident AF. During a median follow-up period of 5.3 years, 154 (4.3%) participants developed AF. In univariable analysis, peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase were significantly associated with the development of AF. PALS [hazard ratio (HR) 1.05, 95% ...
AimsThe degree of cardiovascular sequelae following COVID‐19 remains unknown. The aim of this stu... more AimsThe degree of cardiovascular sequelae following COVID‐19 remains unknown. The aim of this study was to investigate whether cardiac function recovers following COVID‐19.Methods and resultsA consecutive sample of patients hospitalized with COVID‐19 was prospectively included in this longitudinal study. All patients underwent an echocardiographic examination during hospitalization and 2 months later. All participants were successfully matched 1:1 with COVID‐19‐free controls by age and sex. A total of 91 patients were included (mean age 63 ± 12 years, 59% male). A median of 77 days (interquartile range: 72–92) passed between the two examinations. Right ventricular (RV) function improved following resolution of COVID‐19: tricuspid annular plane systolic excursion (TAPSE) (2.28 ± 0.40 cm vs. 2.11 ± 0.38 cm, P < 0.001) and RV longitudinal strain (RVLS) (25.3 ± 5.5% vs. 19.9 ± 5.8%, P < 0.001). In contrast, left ventricular (LV) systolic function assessed by global longitudinal st...
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Papers by Gorm Jensen