Diagnostic Value of Exercise Electrocardiography and Thallium Myocardial Scintigraphy in Patients Without Previous Myocardial Infarction: A Bayesian Approach
Diagnostic Value of Exercise Electrocardiography and Thallium Myocardial Scintigraphy in Patients Without Previous Myocardial Infarction: A Bayesian Approach
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运动心电图和铊心肌闪烁扫描对无心肌梗塞病史的患者的诊断价值：贝叶斯方法
DOI：
10.1161/01.cir.63.5.1019
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发表时间：
1981
期刊：
影响因子：
37.8
通讯作者：
J. Detry
中科院分区：
文献类型：
--
作者：
J. Melin;L. Piret;R. Vanbutsele;M. Rousseau;J. Cosyns;L. Brasseur;C. Beckers;J. Detry
本文对160例（男130例，女30例）疑有冠心病（CAD）并行冠状动脉造影的患者，进行了运动心电图（ECG）和运动后铊（~（201）T_1）显像联合应用的临床价值评价。根据性别和病史，将患者分为CAD患病率不同的两组：组1（CAD的高患病率= 90%）包括98例典型心绞痛（AP）和组2（冠心病低患病率= 18%）包括32名男性和30名女性不典型AP。心肌灌注显像对冠心病的诊断敏感性（87%比74%）和特异性（89%比70%）更高。如果两种检测结果一致，则ECG和心电图数据的组合是有用的：100%的真阳性（n = 67）和84%的真阴性（n = 43）。在结果不一致的情况下（n = 50），由于许多假阳性（27%）和假阴性（25%），无法做出明确的诊断结论。根据贝叶斯定理，当患病率高时，异常的运动结果确认CAD，当患病率低时，正常的结果排除CAD;此外，当患病率高时，对运动的正常反应没有预测价值。当患病率较低时，异常心电图或铊的预测价值较低，但一致的异常反应对CAD具有高度预测性（100%真阳性）。
The clinical value of combining exertional ECG and postexertional thallium (201T1) scintigraphy was assessed in 160 patients (130 men and 30 women) suspected of having coronary artery disease (CAD) who underwent a coronary arteriography. Based on sex and history, the patients were subdivided in two groups with different prevalences of CAD: Group 1 (high prevalence of CAD = 90%) included 98 men with typical angina pectoris (AP) and group 2 (low prevalence of CAD = 18%) included 32 men and 30 women with atypical AP.Compared with the exertional ECG, myocardial scintigraphy was more sensitive (87% vs 74%) and more specific (89% vs 70%) for the diagnosis of CAD. The combination of the ECG and scintigraphic data was useful if both tests gave concordant results: 100% of true positives (n = 67) and 84% of true negatives (n = 43). In case of discordant results (n = 50), no firm diagnostic conclusion could be made due to the many false-positive (27%) and false-negative (25%) scintigrams.These results are easier to interpret when the prevalence of CAD is taken into account. According to Bayes' theorem, abnormal exercise results confirm CAD when the prevalence is high and normal results rule out CAD when the prevalence is low; also, a normal response to exercise has no predictive value when the prevalence is high. When the prevalence is low, an abnormal ECG or thallium has low predictive value but concordant abnormal responses are highly predictive for CAD (100% of true positives).