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[Implication of probability analysis for diagnosis of stable coronary diseases. Comparison of non-invasive diagnostic
Michał Lewandowski1, Hanna Szwed, Ilona Kowalik
1Klinika Choroby Wieńcowej Instytutu Kardiologii w Warszawie.
Insights
Clinical evaluation of chest pain effectively estimates coronary artery disease (CAD) probability. Non-invasive tests like stress echocardiography (SE) and exercise electrocardiography (EE) aid diagnosis, with SE showing higher specificity.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Stable angina pectoris diagnosis relies on clinical evaluation and non-invasive testing.
- Accurate assessment of coronary artery disease (CAD) is crucial for patient management.
- Previous studies highlight varying diagnostic values of different non-invasive tests.
Purpose of the Study:
- To evaluate the diagnostic performance of clinical assessment, electrocardiography (ECG), exercise electrocardiography (EE), and dobutamine stress echocardiography (SE) in patients with chest pain.
- To develop and assess algorithms incorporating these tests for improved CAD probability estimation.
- To guide the selection of non-invasive testing strategies based on pre-test probability of CAD.
Main Methods:
- Prospective study of 551 patients with suspected stable angina.
- Data collected included clinical history, ECG, EE, SE, and coronary angiography (CA).
- Diagnostic algorithms were developed using pretest variables and non-invasive test results.
Main Results:
- Clinical evaluation, including chest pain classification, is effective in estimating CAD probability.
- Resting ECG has low diagnostic value (sensitivity 23%, specificity 87%).
- EE showed high sensitivity (93%) but low specificity (21%), while SE had lower sensitivity (85%) but higher specificity (69%).
- Developed algorithms achieved 96% sensitivity and 44% specificity for CAD detection.
Conclusions:
- Chest pain characteristics remain a key factor in estimating CAD probability.
- Dobutamine stress echocardiography (SE) offers comparable sensitivity to exercise electrocardiography (EE) but with significantly higher specificity.
- Non-invasive testing may not be necessary when CAD likelihood is high; test selection (SE vs. EE) should differ for men and women with intermediate/low probability.
Unlabelled:
A prospective collection of clinical (history), electrocardiography (ECG), exercise electrocardiography (EE), dobutamine stress echocardiography (SE) and catheterization data was performed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. All patients (65% male) without prior history of myocardial infarction undergone clinical evaluation: chest pain classification according to Diamond, ECG, EE (regarded as positive on the basis of > or = 1 mm ST-depression), SE (ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model) and coronary angiography (CA):CAD was defined as > or = 50% narrowing of at least one major vessel. Sensitivity and specificity of ECG, EE, SE was calculated: and results are as follows respectively: 23% and 87%, 93% and 21%, 85% and 69%. On the basis of these results with implication of probability analysis two algorithms were developed by computer program. They incorporated pretest variables: age, gender, chest pain classification, ECG and results of one or two non-invasive tests: EE and (or) SE. The sensitivity and specificity of the algorithm is 96% and 44%.
Conclusions:
1. Chest pain characteristics remains an effective tool for estimating probability of CAD. 2. The diagnostic value of resting electrocardiography in stable CAD is low. 3. SE has comparably sensitivity but significantly higher specificity than EE. 4. We demonstrated that when the likelihood of CAD is high on the basis of initial evaluation, diagnostic non-invasive testing is not indicated before CA. 5. When the probability is intermediate or low, implementation of first choice test should be different in women (SE) and men (EE).
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An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...