Environmental impact of cardiac imaging tests for the diagnosis of coronary artery disease

The use of cardiovascular imaging is growing inexorably and concerns have been expressed about its cost and radiation safety. In this study, the relative environmental impact of MRI, single photon emission tomography and cardiac ultrasound (echo) for the diagnosis of coronary artery disease were examined. The results emphasise that echo causes the least environmental impact at each stage of its life cycle. The effect of one echo on human health, ecosystem effects and resource use was of the order of 1-20% of those of the alternative methods. Although there are circumstances in which one imaging modality is preferred on clinical grounds, when everything else is equal, these results support the selection of echocardiography as the preferred test on environmental grounds.     

A comparison of methods of analysing exercise tests for diagnosis of coronary artery disease

The diagnostic accuracy of the following methods of analysing exercise tests were evaluated: (a) the cumulative area of ST segment depression during exercise normalised for workload and heart rate (exercise score); (b) discriminant analysis of electrocardiographic exercise variables, workload, and symptoms; and (c) ST segment amplitude changes during exercise adjusted for heart rate. Three hundred and forty five men without a history of myocardial infarction were studied. One hundred and twenty three were apparently healthy. Less than half (170) had coronary artery disease. All had a normal electrocardiogram at rest. A Frank lead electrocardiogram was computer processed during symptom limited bicycle ergometry. The accuracy of the exercise score (a) was low (sensitivity 67%, specificity 90%). Discriminant analysis (b) and ST segment amplitude changes adjusted for heart rate (c) had excellent diagnostic characteristics (sensitivity 80%, specificity 90%), which were little affected by concomitant use of beta blockers. Both methods seem well suited for diagnostic application in clinical practice.     

Exercise thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease

OBJECTIVE: To determine the discriminant accuracy of exercise thallium-201 myocardial perfusion scintigraphy for the diagnosis and prognosis of patients with known or suspected coronary artery disease. DATA IDENTIFICATION: A survey of the National Library of Medicine MEDLINE database. STUDY SELECTION: The key medical subject headings used were coronary disease, myocardial infarction, radionuclide imaging, and thallium. A total of 122 retrieved studies were considered relevant and were reviewed in depth. DATA EXTRACTION: Only studies reporting both the sensitivity and specificity of thallium scintigraphy were analyzed. RESULTS: Discriminant accuracy for diagnosis and prognosis was summarized in terms of pooled sensitivity and specificity. CONCLUSIONS: Exercise thallium scintigraphy is useful in the noninvasive diagnosis of coronary artery disease, especially in patients with abnormal resting electrocardiograms, restricted exercise tolerance, and intermediate probability of having disease at the time of testing as well as of defining the prognosis of patients with known or suspected coronary artery disease, especially in those with previous myocardial infarction. Because of various shortcomings in the published record, however, the marginal discriminant accuracy and cost effectiveness of thallium scintigraphy compared with conventional clinical assessment and exercise electrocardiography remain controversial.     

A comparison of methods of analysing exercise tests for diagnosis of coronary artery disease.

The diagnostic accuracy of the following methods of analysing exercise tests were evaluated: (a) the cumulative area of ST segment depression during exercise normalised for workload and heart rate (exercise score); (b) discriminant analysis of electrocardiographic exercise variables, workload, and symptoms; and (c) ST segment amplitude changes during exercise adjusted for heart rate. Three hundred and forty five men without a history of myocardial infarction were studied. One hundred and twenty three were apparently healthy. Less than half (170) had coronary artery disease. All had a normal electrocardiogram at rest. A Frank lead electrocardiogram was computer processed during symptom limited bicycle ergometry. The accuracy of the exercise score (a) was low (sensitivity 67%, specificity 90%). Discriminant analysis (b) and ST segment amplitude changes adjusted for heart rate (c) had excellent diagnostic characteristics (sensitivity 80%, specificity 90%), which were little affected by concomitant use of beta blockers. Both methods seem well suited for diagnostic application in clinical practice.     

Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease

OBJECTIVE: This study sought to compare the accuracy of myocardial contrast echocardiography (MCE) and wall motion analysis (WMA) during submaximal and peak dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD). BACKGROUND: The relative merits of MCE and WMA for the detection of CAD during DSE have not been studied in a large number of patients. METHODS: We studied 170 patients who underwent dobutamine (up to 50 microg/kg/min)-atropine stress testing and coronary angiography. The WMA and MCE (using repeated boluses of Optison [Mallinckrodt, St. Louis, Missouri] or Definity [Bristol-Myers Squibb, New York, New York]) were performed at rest, at intermediate stress (65% to 75% of maximal heart rate), and at peak stress. The diagnosis of CAD (>/=50% stenosis in >/=1 coronary artery) was based on reversible wall motion and perfusion abnormalities. RESULTS: Coronary artery disease was detected in 127 (75%) patients. Sensitivity of MCE was higher than that of WMA at maximal stress (91% vs. 70%; p = 0.001) and at intermediate stress (84% vs. 20%; p = 0.0001). Specificity was lower for MCE compared with WMA (51% vs. 74%; p = 0.01). Overall accuracy was higher for MCE than for WMA (81% vs. 71%; p = 0.01). Sensitivity for detection of CAD based on abnormalities in >/=2 vascular regions was higher for MCE than for WMA (67% vs. 28%; p < 0.01). CONCLUSIONS: The majority of inducible perfusion abnormalities occur at an intermediate phase of the stress test, without wall motion abnormalities. Myocardial contrast echocardiography provides better sensitivity than WMA, particularly in patients with submaximal stress and in identifying patients with multivessel CAD.     

多支冠脉病变不完全血运重建的远期预后

目的以残余SYNTAX积分(rSS)定量评价不完全血运重建,探讨其对多支病变患者行经皮冠脉介入(PCI)治疗的远期预后评价。方法入选2010年1月至2011年6月在天津胸科医院经冠状动脉造影证实为多支病变并行PCI治疗患者653例。根据PCI术前和术后冠状动脉造影结果计算SYNTAX积分和残余SYNTAX积分。根据rSS分为:rSS≤4(207例);48(177例)。随访3~4年终点事件发生率。结果 653例患者中失访104例,与rSS≤4组和48组MACCE发生率(x~2=15.347,P<0.05)、心原性死亡率(x~2=7.383,P<0.05)、再次血运重建率(x~2=6.485,P<0.05)均明显升高,全因死亡率也明显增高(x~2=7.742,P<0.05)。Kaplan-Meier生存分析显示,rSS>8组患者长期无事件生存率明显低于rSS≤4和4相似文献   

无创性动脉硬化检测技术对冠心病早期诊断价值的评估

目的：探讨无创性动脉硬化指标颈动脉内中膜厚度（IMT）、踝臂指数（ABI）、脉搏波传导速度（PWV）与冠状动脉粥样硬化程度的相关性以及对冠心病的早期预测价值. 方法：随机选择我院进行冠状动脉造影的133例可疑冠心病患者,进行IMT、ABI、PWV检测.用Gensini积分评价冠状动脉病变程度,采用线性相关系数分析Gensini积分与IMT、ABI和PWV的相关性,观察这些无创性动脉硬化指标对冠心病的早期预测价值. 结果：（1） IMT与Gensini积分明显相关（P=0.000）,IMT数值越大Gensini积分越高;ABI和PWV与Gensini积分无相关性.（2）绘制IMT、ABI和PWV预测冠心病的ROC曲线,IMT的曲线下面积为0.815,预测冠心病的灵敏度为62.7％,特异度为92.9％;ABI和PWV对冠心病的预测价值不显著. 结论：无创性动脉硬化指标IMT与冠状动脉粥样硬化的严重程度有明显的相关性,对冠心病有较好的早期预测价值,而ABI和PWV对冠心病无明显早期预测价值.     

Exercise treadmill score for predicting prognosis in coronary artery disease

To determine the prognostic value of the treadmill exercise test, we evaluated 2842 consecutive patients with chest pain who had both treadmill testing cardiac catheterization. The population was randomly divided into two equal-sized groups and the Cox regression model was used in one to form a treadmill score that was then validated in the other group. The final treadmill score was calculated as follows: exercise time--(5 X ST deviation)--(4 X treadmill angina index). Using this treadmill score, 13% of the patients were found to be at high risk; 53%, at moderate risk; and 34%, at low risk. The treadmill score added independent prognostic information to that provided by clinical data, coronary anatomy, and left ventricular ejection fraction: patients with three-vessel disease with a score of -11 or less had a 5-year survival rate of 67%, and those with a score of +7 or more had a 5-year survival rate of 93%. The treadmill score was useful for stratifying prognosis in patients with suspected coronary artery disease who were referred to us for catheterization, and may provide a useful adjunct to clinical decision making in the larger population of patients being evaluated for chest pain.     

Diagnostic accuracy of carotid ultrasonography in screening for coronary artery disease

OBJECTIVES: This study investigated the diagnostic accuracy of carotid ultrasonography in screening for significant coronary artery disease (% diameter stenosis > or = 75%). METHODS: Five hundred sixty patients (342 males, 218 females, mean age 66.4 years) underwent both coronary angiography and carotid ultrasonography. Gensini's coronary score was calculated as a quantitative parameter of coronary atherosclerosis. The most hypertrophic intimal-medial complex thickness (IMT) of the bilateral common carotid arteries (distal and proximal to the echo probe in each artery) was measured within 2 or 3 cm from the carotid bifurcation. The mean IMT (mean of these 4 sites), the maximum IMT (maximum of these 4 sites), and number of plaques (localized hypertrophy of IMT > or = 1.1 mm) were calculated as a quantitative parameter of carotid atherosclerosis. RESULTS: The screening parameters were determined as 0.85 mm mean IMT, 1.1 mm maximum IMT, and at least 2 sites of plaque. The sensitivity, specificity and accuracy rate for the detection of coronary artery disease were 57.3%, 61.6% and 59.6% for mean IMT, 43.5%, 71.1% and 58.6% for maximum IMT, and 60.8%, 70.5% and 66.1% for number of plaques. Furthermore, the overall results (except maximum IMT) were 73.3%, 49.2% and 60.2%. CONCLUSIONS: These results suggest that carotid ultrasonography is useful as a non-invasive and easy screening method for coronary artery disease. Furthermore, carotid ultrasonography will allow routine observations to follow the progression of coronary atherosclerosis.     

冠心病患者高频心电图与冠状动脉造影的对比研究

本文报道１０１例冠状动脉造影的冠心病患者高频心电图（ＨＦＥＣＧ）变化。结果提示:高频切迹数随冠状动脉狭窄程度的加重而增多，ＨＦＥＣＧ与ＥＣＧ诊断中、重度冠状动脉狭窄的灵敏度分别为８７．７％～９５．４％与６６．２％，ｐ＜０．０１；特异性分别为７２．２％～７５．０％与６３．９％，Ｐ＞０．０５；符合率分别为８３．２％～８７．１％与６５．３％，Ｐ＜０．０１。