Diagnostic accuracy of myocardial perfusion imaging in a study population without post-test referral bias

Johansen, Allan; Høilund‐Carlsen, Poul Flemming; Christensen, Henrik Wulff; Vach, Werner; Jørgensen, Henrik Boel; Veje, Annegrete; Haghfelt, Torben

doi:10.1016/j.nuclcard.2005.04.012

Cited by 35 publications

(26 citation statements)

References 45 publications

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“…Since the prevalence of obstructive CAD (C70% stenosis) in the 208 patients included in the study was high (68.8%), the data of additional 76 patients with very low 10-year risk, who did not have ICA were included. 23 Using the QPS software with custom-developed normal limits, quantitative stress-TPD from supine and prone acquisitions yielded high diagnostic values (AUC [ 0.9) in both patient subgroups. Sensitivities were high in the lowdose and standard-dose subgroups (86.1% and 90.6%, respectively, P = ns) with lower specificities (76.6% and 78.1%, P = ns), reflecting post-test referral bias to ICA.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera

Sharir

Pinskiy

Pardes

et al. 2016

Journal of Nuclear Cardiology

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Section: Discussionmentioning

confidence: 99%

Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera

Sharir

Pinskiy

Pardes

et al. 2016

Journal of Nuclear Cardiology

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“…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.…”

mentioning

confidence: 68%

“…This study has a number of companion publications (6)(7)(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).…”

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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“…Final interpretation and overall diagnosis were determined by consensus. The diagnostic accuracy of this approach has been reported elsewhere (21). The MPS results were not revealed to the referring physician.…”

Section: Mpsmentioning

confidence: 80%

“…Both left ventricular hypertrophy (more than 75% of our study population had a history of hypertension) and microvascular disease may be associated with perfusion abnormalities in the presence of normal coronary arteries (21,30,31). The precise impact of these confounders remains unknown; however, hypertension does not degrade the diagnostic value of MPS for diagnosing coronary artery disease (32), and none of the factors can explain the high rate of insignificant angiographic disease in these patients.…”

Section: Discussionmentioning

confidence: 97%

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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Diagnostic accuracy of myocardial perfusion imaging in a study population without post-test referral bias

Abstract: In this prospective study without post-test referral bias, we found a lower sensitivity and slightly higher specificity than in studies with post-test referral bias. The imperfect accuracy may reflect differences between anatomic and physiologic imaging.

Cited by 35 publications

References 45 publications

Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera

Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera

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

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

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