Critical analysis of the application of bayes' theorem to sequential testing in the noninvasive diagnosis of coronary artery disease

Weintraub, William S.; Madeira, Samuel W.; Bodenheimer, Monty M.; Seelaus, Paul A.; Katz, Robert I.; Feldman, Michael; Agarwal, Jai B.; Banka, Vidya S.; Helfant, Richard H.

doi:10.1016/0002-9149(84)90301-1

Cited by 62 publications

(8 citation statements)

References 18 publications

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“…Consistent with previous reports the sensitivity of EECG increased with the extent of CAD (Clavert et al, 1984;Campos et al, 1983;Cheitlin et al, 1975;Cohn et al, 1972;Goldschlager et al, 1976;McNeer et al, 1978;Raffo et al, 1979;Rijneke et al, 1980;Tonkon et al, 1977;Weintraub et al, 1984). This took place in all analyzed ST change levels.…”

Section: Discussionsupporting

confidence: 92%

Studies on ergometer exercise testing I. Significance of the type of st‐segment response, sex, and chest pain

Pellinen¹,

Virtanen²,

Valle³

et al. 1986

Clinical Cardiology

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Summary:Ergometer exercise electrocardiographic (EECG) data were surveyed in a series of 328 patients (277 men and 5 1 women) subjected to coronary arteriography. The sensitivity and specificity of EECG for coronary artery disease (CAD) were 84% and 54%, respectively. The predictive accuracy of a positive test for CAD was 95% in men and 81 % in women. The predictive accuracy of a negative test was 25% in men and 62% in women. When slowly ascending ST depression was considered insignificant, the sensitivity of EECG declined to 71 %, with an increase in specificity to 64%. CAD was present in 89% of the patients with slowly ascending ST depression and 65% of them had a multivessel disease. Seventy-two subjects had postexercise ST-segment elevation. The predictive value of this sign for CAD was 94%. Exercise-induced chest pain had quite a similar diagnostic significance as EECG. The prevalence of CAD in patients with a history of typical angina was 94% in both sexes. Atypical chest pain was associated with normal coronary arteriography in 59% of males and 100% of females.

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Section: Discussionsupporting

confidence: 92%

Studies on ergometer exercise testing I. Significance of the type of st‐segment response, sex, and chest pain

Pellinen¹,

Virtanen²,

Valle³

et al. 1986

Clinical Cardiology

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“…Essa seria uma metodologia equivocada na avaliação da acurácia de um teste, diminuindo artificialmente a especificidade ou a capacidade do método em selecionar os indivíduos sadios de uma população. 131,132 Por outro lado, a sensibilidade elevar-se-á expressivamente naqueles encaminhados com alta prevalência de sintomas.…”

Section: A Aplicação Do Teorema De Bayes Na Análise Das Imagens De Peunclassified

Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020

Mastrocola

Amorim

Vítola³

et al. 2020

ABC Cardiol

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“…Bias in posterior probability estimates from Bayes' theorem has been explored with regard to literature versus locally derived data, 4 verification bias, 5 and lack of conditional independence. [6][7][8][9][10][11][12][13][14][15][16] Bayes' theorem can work well when independence is assumed, 6,7,12,15,16 but violations of the independence assumption can degrade diagnostic accuracy. [7][8][9][10] Proposed solutions include rankordering variables according to degree of intercorrelation, 8 selecting variables based on whether they increase diagnostic accuracy, 13,14 or using discriminant function analysis.…”

mentioning

confidence: 99%

Quantitative Assessments from the Clinical Examination: How Should Clinicians Integrate the Numerous Results?

Holleman

Simel

1997

J GEN INTERN MED

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OBJECTIVE:To describe strategies for using multiple clinical examination items to estimate disease probabilities; and to evaluate the diagnostic accuracy of each strategy. DESIGN: Prospective observational study.SETTING: Medical preoperative evaluation clinic at a university-affiliated Veterans Affairs Medical Center. PATIENTS:Previously reported consecutive series of patients referred for outpatient medical preoperative risk assessment. MEASUREMENTS AND MAIN RESULTS:Pulmonary clinical examination and spirometry were the measurements. A strategy of using likelihood ratios (LRs) from seven clinical examination items was least accurate ( p Ͻ .0001). Three alternative strategies were equivalent in diagnostic accuracy ( p Ն .2): (1) using the single best clinical examination item and its LR, (2) using the LRs from three clinical examination items chosen by logistic regression, and (3) using the adjusted LRs chosen in strategy 2. When compared with using LRs from all seven items, the strategies of using three LRs chosen by logistic regression or using adjusted likelihood ratios better discriminated patients with airflow limitation from those without ( he clinical examination comprises the medical history and the physical examination. Each component of the clinical examination can be considered a separate diagnostic test. As such, clinicians must choose how to incorporate the numerous results obtained from eliciting the patient's history and performing a physical examination into their clinical decision making. Some of these results will be highly relevant, whereas others ought to have little impact on clinical decisions. This process of determining the relevance of clinical examination results is twofold: first, is the result statistically associated with the target disorder; and second, how much does the result contribute to the diagnosis above other clinical examination results? To make these decisions about relevance, clinicians need a summary measure of the impact of a given clinical examination result on the likelihood of the target disorder.Likelihood ratios (LRs) are convenient summary measures of diagnostic test performance. They describe the prevalence of a diagnostic test result in patients with a condition of interest versus the prevalence of the same test result among people without the condition. 1 Whether the test yields dichotomous, ordinal, or continuous results, LRs convey a similar type of diagnostic information. Clinicians can use LRs to modify their estimated prior odds of a target disorder to arrive at the posterior odds of the disorder. When there is a single diagnostic test, posterior odds is simply the product of prior odds and the LR for the test result.

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Critical analysis of the application of bayes' theorem to sequential testing in the noninvasive diagnosis of coronary artery disease

Cited by 62 publications

References 18 publications

Studies on ergometer exercise testing I. Significance of the type of st‐segment response, sex, and chest pain

Studies on ergometer exercise testing I. Significance of the type of st‐segment response, sex, and chest pain

Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020

Quantitative Assessments from the Clinical Examination: How Should Clinicians Integrate the Numerous Results?

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