BACKGROUND: The diagnostic value and incremental contribution of different noninvasive tests to the identification of coronary artery disease in 128 patients from a general population with intermediate pretest likelihood (48.0%) were determined by ordered logistic regression analysis and receiver-operating characteristic (ROC) curves. METHODS AND RESULTS: Patients referred for suspicion of coronary heart disease were submitted to bicycle exercise testing under clinical and electrocardiographic control. AT peak exercise, first-pass radionuclide angiography was performed after injection of 99mTc-labeled sestamibi, followed by single-photon emission computed tomographic (SPECT) acquisition. A comparative rest study was obtained within 1 week, and qualitative and quantitative analysis was applied to assess the presence and extent of disease. With coronary angiography and 50% stenosis used as a standard, the discriminative accuracy of each test was calculated. The accuracies to diagnose coronary heart disease were 71.3% +/- 4.7% for the bicycle test, 66.7% +/- 5.3% for radionuclide angiography, and 81.6% +/- 3.9% for the SPECT data. By ROC curves, the optimal criteria for positivity were determined for the visual and quantitative analysis for both presence and extent of coronary artery disease. Results of visual and quantitative SPECT were compared in terms of area under the ROC curves. The diagnostic performances showed no significant difference, ranging from 74.3% to 81.6%. The first-pass radionuclide angiographic and SPECT data were added progressively to the stress testing to evaluate their incremental diagnostic contribution. Only the addition of SPECT results significantly increased the accuracy to 85.6% +/- 3.3% (p < 0.0001). CONCLUSION: Exercise electrocardiography and first-pass radionuclide angiography showed comparable accuracy to detect coronary artery disease. However, the combination of exercise testing and visual SPECT analytic data sufficed to ensure diagnostic accuracy, without significant benefit from the addition of other tests or the application of quantification.
BACKGROUND: The diagnostic value and incremental contribution of different noninvasive tests to the identification of coronary artery disease in 128 patients from a general population with intermediate pretest likelihood (48.0%) were determined by ordered logistic regression analysis and receiver-operating characteristic (ROC) curves. METHODS AND RESULTS:Patients referred for suspicion of coronary heart disease were submitted to bicycle exercise testing under clinical and electrocardiographic control. AT peak exercise, first-pass radionuclide angiography was performed after injection of 99mTc-labeled sestamibi, followed by single-photon emission computed tomographic (SPECT) acquisition. A comparative rest study was obtained within 1 week, and qualitative and quantitative analysis was applied to assess the presence and extent of disease. With coronary angiography and 50% stenosis used as a standard, the discriminative accuracy of each test was calculated. The accuracies to diagnose coronary heart disease were 71.3% +/- 4.7% for the bicycle test, 66.7% +/- 5.3% for radionuclide angiography, and 81.6% +/- 3.9% for the SPECT data. By ROC curves, the optimal criteria for positivity were determined for the visual and quantitative analysis for both presence and extent of coronary artery disease. Results of visual and quantitative SPECT were compared in terms of area under the ROC curves. The diagnostic performances showed no significant difference, ranging from 74.3% to 81.6%. The first-pass radionuclide angiographic and SPECT data were added progressively to the stress testing to evaluate their incremental diagnostic contribution. Only the addition of SPECT results significantly increased the accuracy to 85.6% +/- 3.3% (p < 0.0001). CONCLUSION: Exercise electrocardiography and first-pass radionuclide angiography showed comparable accuracy to detect coronary artery disease. However, the combination of exercise testing and visual SPECT analytic data sufficed to ensure diagnostic accuracy, without significant benefit from the addition of other tests or the application of quantification.
Authors: V Di Bello; E Gori; C R Bellina; O Parodi; N Molea; G Santoro; G Mariani; U Conti; E Magagnini; P Marzullo Journal: J Nucl Cardiol Date: 1994 Jul-Aug Impact factor: 5.952
Authors: K F Van Train; E V Garcia; J Maddahi; J Areeda; C D Cooke; H Kiat; G Silagan; R Folks; J Friedman; L Matzer Journal: J Nucl Med Date: 1994-04 Impact factor: 10.057
Authors: P R Franken; A Vervaet; R Ranquin; S Lieber; P van den Heuvel; F van den Branden; A A Dobbeleir; J Vandevivere Journal: Eur Heart J Date: 1992-09 Impact factor: 29.983
Authors: E E DePasquale; A C Nody; E G DePuey; E V Garcia; G Pilcher; C Bredlau; G Roubin; A Gober; A Gruentzig; P D'Amato Journal: Circulation Date: 1988-02 Impact factor: 29.690
Authors: A Elhendy; F B Sozzi; R T van Domburg; J J Bax; M L Geleijnse; R Valkema; E P Krenning; J R Roelandt Journal: J Nucl Cardiol Date: 2000 Sep-Oct Impact factor: 5.952