Head-to-head comparison of multislice computed tomography and exercise electrocardiography for diagnosis of coronary artery disease

Dewey, Marc; Dübel, Hans-Peter; Schink, Tania; Baumann, Gert; Hamm, Bernd

doi:10.1093/eurheartj/ehl148

Cited by 41 publications

(33 citation statements)

References 38 publications

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“…Among the studies included, two studies also included the analysis of cost and length of stay. One study showed the CCTAbased evaluation was less expensive than ExECG, while the other study pointed out the CCTA was more expensive than exercise test; (II) even though the total female radio was improved, but it still did not meet the best proportion (1:1), the low proportion of women in the present meta-analysis might have contributed to the higher specificity of ExECG, because exercise testing is known to have lower diagnostic performance on women than on men (7,26); (III) in ExECG arm, all of the effect sizes were highly heterogeneous, which might affect the pooled effect sizes.…”

Section: Discussionmentioning

confidence: 57%

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Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Yin¹,

Wang²,

Zheng³

et al. 2016

J. Thorac. Dis.

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Background: Both coronary computed tomography angiography (CCTA) and exercise electrocardiography (ExECG) are non-invasive testing methods for the evaluation of coronary artery disease (CAD). However, there was controversy on the diagnostic performance of these methods due to the limited data in each single study. Therefore, we performed a meta-analysis to address these issues. Methods: We searched PubMed and Embase databases up to May 22, 2015. Two authors identified eligible studies, extracted data and accessed quality. Pooled estimation of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver-operating characteristic curve (SROC) and the area under curve (AUC) of CCTA and ExECG for the diagnosis of CAD were calculated using Stata, Meta-Disc and Review Manager statistical software. and 0.7727±0.0638, respectively. There is no heterogeneity caused by threshold effect in CCTA or ExECG analysis. The Deeks' test showed no potential publication bias (P=0.17).Conclusions: CCTA has better diagnostic performance than ExECG in the evaluation of CAD, which can provide a better solution for the clinical problem of the diagnosis for CAD. J Thorac Dis 2016;8(7):1688-1696 jtd.amegroups.com standard for assessing anatomical stenosis severity, a variety of non-invasive testing methods have been advocated recently to provide an anatomic and/or functional evaluation of coronary artery. Available methods include exercise/stress electrocardiography (ExECG), single proton emission computed tomography (SPECT), myocardial perfusion imaging (MPI), coronary computed tomography angiography (CCTA) and coronary computed tomography with fractional flow reserve (FFRCT). Despite these facts, assessment of the presence of CAD remains challenging.Among these diagnostic methods, ExECG is a wellestablished and inexpensive procedure to evaluate intermediate risk patients with angina pectoris (2). However, ExECG has relatively limited diagnostic performance in patients with silent CAD (3). As a new non-invasive alternative test, CCTA has high diagnostic performance to rule out CAD (4,5). Moreover, CCTA can be used in patients with equivocal stress test or unable to exercise stress test (6). But this method also suffers a number of limitations, such as a progressive loss of sensitivity and specificity as the pretest probability of disease decreases (7).To date, several studies have compared the effectiveness of CCTA with that of ExECG for the diagnosis of CAD (8)(9)(10)(11)(12)(13)(14). But there was controversy about the specificity of two arms (12,13). Additionally, a major limitation of these investigations was their reliance, by necessity, on observational studies due to the limited data in each single study. Therefore, we performed a meta-analysis to compare the diagnostic performance of CCTA and ExECG for CAD based on a larger data, which indicates a more specific comparison about the value of anatomic and functional evaluation in clinical decisions. Methods ...

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Section: Discussionmentioning

confidence: 57%

“…Moreover, CCTA can be used in patients with equivocal stress test or unable to exercise stress test (6). But this method also suffers a number of limitations, such as a progressive loss of sensitivity and specificity as the pretest probability of disease decreases (7).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Yin¹,

Wang²,

Zheng³

et al. 2016

J. Thorac. Dis.

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“…[78][79][80][81] This evaluation can be requested by a cardiologist, primary care physician, andrologist, or urologist with specialized training in cardiovascular risk assessment. The 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults 5 Despite its limitations in detecting CVD without significant stenosis, EST (with or without imaging) can further define the cardiovascular risk in patients with ED and may be particularly helpful for identifying silent CAD in patients with diabetes.…”

Section: Treatment Additional Cardiovascular Evaluation and Referralmentioning

confidence: 99%

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

Nehra

Jackson

Miner

et al. 2012

Mayo Clinic Proceedings

407

341

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The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction. T he Princeton Consensus Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The first conference convened in June 1999 to develop recommendations for clinical management of sexual dysfunction in men and women with known cardiovascular disease (CVD). This conference also provided a multidisciplinary forum for evaluation of the potential cardiovascular risk posed by sexual activity in atrisk patients. The first Princeton Consensus Conference recommendations 1 included stratification of patients by level of cardiac risk associated with sexual activity based on existing CVD. Those at low risk could initiate or resume sexual activity and be treated for sexual dysfunction. For those at high risk, sexual activity was deferred until the cardiac condition was stabilized. The second Princeton Consensus Conference convened in June 2004 and expanded the recommendations of the first conference to emphasize risk factor evaluation and lifestyle management for all men with erectile dysfunction (ED). 2 The second conference recommendations also incorporated new information on the appropriate use of phosphodiesterase type 5 (PDE5) inhibitors in men with ED and concomitant CVD.The third Princeton Consensus Conference took place November 8 to 10, 2010, in Miami Beach, Florida. The group revisited and updated their 2005 recommendations regarding the cardiovascular risk associated with sexual activity in men with known CVD. 2 In addition, the third conference focused on the predictive value of vasculogenic ED in assigning cardiovascular risk in men of all ages, with the primary objective being development of an approach to cardiovascular risk assessment in younger men with ED and no known CVD. The role of testosterone in erectile function and cardiovascular health and the utility of testosterone replacement...

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“…In three previous studies of patients suspected of angina and with intermediate to high pretest risk of CAD, the diagnostic performance of CTA in detecting significant CAD was consistently higher as compared to Ex-test with sensitivities and specificities of 91-100% and 80-87% for CTA versus 45-78% and 31-67% for Ex-test [12,16,17]. This study of symptomatic patients at low-intermediate pretest probability of CAD add to previous findings by showing that the inferior diagnostic performance of Ex-test relative to CTA is associated with a 50% higher rate in DTU.…”

Section: Discussionmentioning

confidence: 83%

Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing

Nielsen

Markenvard

Jensen

et al. 2010

Int J Cardiovasc Imaging

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It has been proposed that the increasing use of coronary computed tomographic angiography (CTA) may introduce additional unnecessary diagnostic procedures. However, no previous study has assessed the impact on downstream test utilization of conventional diagnostic testing relative to CTA in patients suspected of angina. The purpose of this study was to investigate the consequences of frontline exercise-stress testing (Ex-test) versus CTA on downstream test utilization in clinical practice. In two collaborating departments using either Ex-test (n = 247) or CTA (n = 251) as the frontline diagnostic test in patients suspected of angina, comparable cohorts of consecutive patients were retrospectively identified (Jan. 2007-Feb. 2008). Downstream test utilization (invasive coronary angiography, ICA; myocardial perfusion scintigraphy, and CTA) during 12 months after the index diagnostic test was recorded. Mean age was 56 years (51% men), and 96% of the total study cohort were at low-intermediate pretest risk of significant coronary disease. Overall, downstream test utilization was more frequent in the Ex-test group than in the CTA group, 32% versus 21% (P = 0.003). Subsequent myocardial scintigraphy was more frequent used (9% versus 4%, P = 0.03), whereas ICA tended to be more frequent applied in the Ex-test versus CTA group (23% vs. 18%, P = 0.15). A frontline diagnostic use in symptomatic patients of Ex-test in comparison to CTA leads to more downstream diagnostic test utilization. Future prospective trials are needed in order to define the most cost-effective diagnostic use of CTA relative to conventional ischemia testing.

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Head-to-head comparison of multislice computed tomography and exercise electrocardiography for diagnosis of coronary artery disease

Abstract: In this consecutive cohort of patients scheduled to undergo conventional coronary angiography, the performance of MSCT for diagnosis of CAD was superior to that of ex-ECG.

Cited by 41 publications

References 38 publications

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing

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