Analysis of Probability as an Aid in the Clinical Diagnosis of Coronary-Artery Disease

Diamond, George A.; Forrester, James S.

doi:10.1056/nejm197906143002402

Cited by 2,434 publications

(1,015 citation statements)

References 61 publications

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“…The simple Diamond and Forrester method we applied was recommended by the Danish Society of Cardiology, but it is not in general use in Denmark. What are the reasons for the discrepancy between our results and those of Diamond et al (12,15)? Despite several cross-tabulations, we did not find any evident clues.…”

Section: Discussioncontrasting

confidence: 80%

“…Therefore, in our analysis, we considered not only the type of angina, but also its severity by CCS grading. For estimating the pretest likelihood of coronary artery disease, we applied the original Diamond and Forrester approach (12), which was based exclusively on age, sex and the type of chest (40) 13 (13) 8 (8) 40 (38) 21 (20) 28 (27) 15 (14) 30 (29) CCS pain grade ≥2 (n=87) 30 (34) 36 (41) 13 (15) 8 (9) 32 (37) 22 (25) 21 (24) 13 (15) 22 (25) High pretest likelihood of 39 (39) 16 (16) 12 (12) 8 (8) 38 (38) 19 (19) 27 (27) 15 (15) 28 (28) coronary artery disease (n=99)…”

Section: Discussionmentioning

confidence: 99%

“…CCS Canadian Cardiovascular Society; VD Vessel disease pain; however, it was not based on other risk factors such as smoking, hyperlipidemia and hypertension, or the results of exercise ECG testing and/or stress thallium imaging, which are included in more elaborate systems (12)(13)(14)(15). We did this because in Denmark, it is not a routine to use any of these systems.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

High probability of disease in angina pectoris patients: Is clinical estimation reliable?

Høilund-Carlsen¹,

Johansen²,

Vach

et al. 2007

Canadian Journal of Cardiology

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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High probability of disease in angina pectoris patients: Is clinical estimation reliable?

Høilund-Carlsen¹,

Johansen²,

Vach

et al. 2007

Canadian Journal of Cardiology

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“…The methods performed in the phantom simulations were applied to 10 patients who had less than 5% likelihood of coronary artery disease (CAD) based on sequential Bayesian analysis of age, gender, and symptom classification (13) . Also, these patients had a normal baseline ECG, no induced ECG changes after pharmacological stress, no major risk factors for CAD or a history of previous cardiac events.…”

Section: Methodsmentioning

confidence: 99%

Quantitative outcome of registration methods for correcting cardiac drift in cardiac PET/CT imaging

Nye

Tudorascu

Esteves

et al. 2016

J Applied Clin Med Phys

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Myocardial perfusion studies suffer from artifacts caused by misalignment of the transmission and emission data due to the influences of voluntary and involuntary patient motion. Regardless of normalG68e or respiratory‐averaged CT based attenuation correction and good patient cooperation, approximately 21% of perfusion studies exhibit artifacts arising from misalignment that cannot be corrected by manipulating the attenuation acquisition protocol. This misalignment, termed cardiac drift, is caused by slow‐moving abdominal cavity contents that reposition the heart in the thorax and appear as myocardial uptake overlying the left CT lung in fused PET/CT images. This study evaluates three postimaging registration techniques to correct PET/CT misalignment by altering the transmission map to match myocardial uptake. Simulated misalignment studies were performed with a cardiac torso phantom filled with [normalF18]FDG at 10:1 myocardium/background. An air‐filled saline bag affixed to the medial left lung surface served as a distensible lung. An initial CT acquisition was followed by successive PET acquisitions consisting of small displacements of the cardiac insert into the left lung. Phantom transmission scans were aligned to the myocardial uptake in the emission scans by applying 1) full rigid‐body translations and rotations, 2) rigid‐body restricted to medial / lateral and superior / inferior translation, or 3) an emission‐driven method that adds myocardial tissue to the transmission scan. These methods were also applied to 10 low‐likelihood coronary artery disease (CAD) patients showing signs of cardiac drift. Full rigid‐body registration showed significant over‐correction (p<0.004) of activity concentrations in the artifact areas of the phantom data due the relocation of highly attenuating structures (i.e., spine). Inaccurate regional activity distributions were also observed as streaks extending from the spine and these results were replicated in the patient population. There was no significant difference between the true phantom activity concentration after correction with the emission‐driven method. Misalignment corrected with the rigid‐body registration results in an increase in activity concentration but fails to accurately recover the true concentration. These data suggest that a nonlinear image registration approach such as an emission‐driven method results in a more uniform activity distribution throughout the myocardium, and is more appropriate for addressing the cardiac drift misalignment problem.PACS number(s): 87.57.uk, 87.57.Q, 87.57.nj, 87.57.C, 87.19.Hh

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“…The subgroups of patients who were thought to have a high probability of disease were then segregated, and the correlation to significant angiographic coronary artery disease was determined. The first grouping was based on the chest pain classification from the Diamond and Forrester scale (9), which separates chest pain into three groups based on patient history. The chest pain types include typical angina, atypical angina and noncardiac chest pain.…”

mentioning

confidence: 99%

Angina pectoris: Has the cornerstone of symptomatic coronary artery disease been moved?

Hessian

2007

Canadian Journal of Cardiology

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But there is a disorder of the breast marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and not extremely rare, which deserves to be mentioned more at length. The seat of it and sense of strangling, and anxiety with which it is attended, may make it not improperly be called angina pectoris. They who are afflicted with it are seized while they are walking (more especially if it be up hill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life, if it were to increase or continue; but the moment they stand still this uneasiness vanishes.William Heberden 1768 (1-3)A classical history of angina pectoris has long been considered to be a symptom of myocardial ischemia and, as such, a predictor of the presence of significant coronary artery disease. The work by Høilund-Carlsen et al (pages 641-647 of the current issue of the Journal) challenges this cornerstone of care.This work provides an interesting window into the correlation of clinical history with the presence of angiographic disease. This study was a substudy of a larger prospective study that looked at myocardial perfusion scintigraphy (MPS) as a gatekeeper for coronary angiography (CA) in patients referred for angiography with angina pectoris and possible coronary artery disease.The data collected for this study are unique. At the time of the study, MPS was not a routine part of the work-up of patients with suspected coronary artery disease in Denmark. The patients were isolated on the island of Funen. Patients were sent directly for angiography from local general practitioners or through local hospitals. Before angiography, they received MPS, and only after the angiogram were the results available to the investigator or clinician. This local practice variation enabled a comparison of MPS with CA in a group of patients who would not normally be selected for angiography based on the results of the MPS study, thus eliminating the effect of 'referral' or 'work-up' bias on the correlation of MPS and CA. Work-up bias has been examined in the literature, and the overall effect is that a greater number of angiograms are performed in patients with abnormal scans. This increases the sensitivity and reduces the specificity of the test being evaluated -in this case, the MPS (4,5).This study has a number of companion publications (6-8); the purpose of the original study was to compare patient findings on MPS with those found on CA. In this population, the overall sensitivity of MPS was found to be 75% and the specificity was 79% (8). At publication, these results were attributed to the absence of a referral or work-up bias.The focus of the current publication was the correlation of clinical features to the angiogram. Three clinical assessment scales were used to classify patients undergoing angiography. The subgroups of patients who were thought to have a high probability of disease were then segregated, and the correlation to significant angiographic cor...

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Analysis of Probability as an Aid in the Clinical Diagnosis of Coronary-Artery Disease

Cited by 2,434 publications

References 61 publications

High probability of disease in angina pectoris patients: Is clinical estimation reliable?

High probability of disease in angina pectoris patients: Is clinical estimation reliable?

Quantitative outcome of registration methods for correcting cardiac drift in cardiac PET/CT imaging

Angina pectoris: Has the cornerstone of symptomatic coronary artery disease been moved?

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