Biomedical subjects

Henrik W Christensen

Publications and source records attributed to Henrik W Christensen.

5 recordsLinked to original sources

PubMed2006

To what degree is amelioration of angina following coronary revascularization associated with improvement in myocardial perfusion?

OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSION: 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.

Aged↗

PubMed2006

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.

OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSION: We could confirm that in patients with known or suspected stable angina, MPI is a valuable risk stratifying tool.

Adult↗

PubMed2003

Is cervical spinal manipulation dangerous?

OBJECTIVE: Concern about cerebrovascular accidents after cervical manipulation is common. We report a case of cerebrovascular infarction without sequelae. CLINICAL FEATURES: A 39-year-old man with nonspecific neck pain was treated by his general practitioner with cervical manipulation. INTERVENTION AND OUTCOME: This immediately elicited severe headache and neurologic symptoms that disappeared completely within 3 months despite permanent signs of a complete left-sided cerebellar infarction on computed tomography and magnetic resonance imaging. At 7-year follow-up the patient was fully employed, and repeated magnetic resonance imaging still showed infarction of the left cerebellar hemisphere. However, the patient remained completely free of neurologic symptoms, and color duplex ultrasonography showed normal cervical vessels, including patent vertebral arteries. CONCLUSION: It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated.

Adult↗

PubMedDate not supplied

Manual therapy for patients with stable angina pectoris: a nonrandomized open prospective trial.

OBJECTIVE: To examine if participants with chest pain originating from the spine would benefit from manual therapy. METHODS: A nonrandomized, open, prospective trial was performed at a tertiary hospital. Patients who were referred for coronary angiography because of known or suspected stable angina pectoris were invited to participate in this study. A total of 275 took part, 50 were diagnosed as cervicothoracic angina (CTA)-positive (chest pain from the cervicothoracic spine) and 225 as CTA-negative. The intervention performed was manual therapy according to chiropractic standards. Patient self reported questionnaires at baseline and 4-week follow-up, including pain measured with an 11-point box scale, Short Form 36 (quality of life), and perceived improvement. RESULTS: Approximately 75% of CTA-positive patients reported improvement of pain and of general health after treatment, compared with 22% to 25% of CTA-negative patients (P < .0001). Pain intensity decreased in both groups with consistently larger decreases for all measures of pain among CTA-positive patients. Short Form 36 scores increased in the CTA-positive group in 5 of 8 scales and remained unchanged in the CTA-negative group. CONCLUSION: This study suggested that patients with known or suspected angina pectoris and a diagnosis of CTA may benefit from chiropractic manual therapy. Methodologically, sound randomized clinical trials are needed to corroborate our results.

Angina Pectoris↗

PubMedDate not supplied

Carotid artery blood flow during premanipulative testing.

BACKGROUND: Cervical manipulation is used millions of times every year. Concern about cerebrovascular accidents (CVAs) is common, but actual cases are rarely reported. Premanipulative tests are presumed to identify patients at risk of CVA. In an earlier study we found no significant changes in the vertebral artery blood flow of patients with a positive premanipulative test with different head positions. Consequently, we questioned whether there is a role for premanipulative testing to identify patients at risk of CVAs. OBJECTIVE: The aim of this study was to examine whether instead, blood flow velocity in the internal carotid arteries changes with head position in patients with a positive premanipulative test, potentially giving contraindication to cervical manipulation. METHODS: In a prospective study private practicing chiropractors from 3 Danish counties referred patients with a positive premanipulative test for an examination of cervical artery blood flow. Premanipulative testing was performed by an experienced chiropractor, and flow velocities were measured in both vertebral and internal carotid arteries by color duplex sonography at a university hospital vascular laboratory. RESULTS: A total of 11 consecutive patients with a positive premanipulative test were referred. Two of these were excluded because we could not reproduce any symptoms at repeat premanipulative testing before the vascular examination. In the remaining 9 patients we found no significant difference with different head positions in peak flow velocity or time-averaged mean flow velocity in the internal carotid arteries. Blood flow did not cease in 1 single patient despite a positive premanipulative test in all. CONCLUSION: It appears that a positive premanipulative test is not associated with a change in peak flow velocity or time-averaged mean flow velocity in either the carotid or the vertebral arteries. If premanipulative testing is used solely for the detection of vascular insufficiency as a potential substrate for CVAs after cervical manipulation, we believe that premanipulative testing is of little clinical value.

Adult↗