Alternative Referent Standards for Cardiac Normality

Abstract

The radionuclide ventriculographic exercise response was evaluated in three patient populations representing alternative referent standards for cardiac normality: patients with normal coronary arteriograms, healthy volunteers, and uncatheterized patients with a low probability of coronary artery disease. Disease probability was determined by Bayesian analysis of age, sex, symptoms, and the results of cardiac fluoroscopy, exercise electrocardiography, or thallium scintigraphy. A wide range of ventriculographic responses was noted in the 62 catheterized normal patients; 21 (34%) had an abnormal ejection fraction response and 22 (35%) had an abnormal wall motion response. In contrast, the ejection fraction and wall motion responses were normal in the 9 volunteers. In 90 patients (18 catheterized and 72 uncatheterized) who had low disease probability (less than 1%), abnormal responses were rare; the ejection fraction response was abnormal in only 7% and the wall motion response was abnormal in 8%. Thus, these three populations are not equivalent referent standards of normality. Volunteers and patients with low disease probability provide too strict a standard, and their use can overestimate test specificity; catheterized normal patients, on the other hand, provide too lenient a standard, and their use can underestimate test specificity.

Effects of Acute Mental Stress and Exercise on T-Wave Alternans in Patients With Implantable Cardioverter Defibrillators and Controls

“…Exclusion criteria were atrioventricular conduction defects, left bundle-branch block, chronic atrial fibrillation, MI Ͻ1 month, unstable angina, class IV congestive heart failure, critical valve pathology, primary cardiomyopathy, use of amiodarone, and age Ͼ80 years. Age-matched normal volunteers (nϭ17) with Ͻ5% likelihood of CAD 22 were tested as controls.…”

Altered Myocardial Vasodilatation in Patients With Hypertriglyceridemia in Anatomically Normal Coronary Arteries

“…For this reason, we assessed cardiac normality on the basis of absence of risk factors for CAD rather than on results of cardiac catheterization, as discussed by Rozanski et al 43 Therefore, even if CAG was not undertaken, we consider our control subjects to be appropriate. Furthermore, given the high diagnostic accuracy of static myocardial PET imaging for CAD, 44 it can be concluded that normal results of PET imaging would indicate normal anatomy and function of coronary arteries in asymptomatic subjects without coronary risk factors or chronic disease.…”

Exercise Seismocardiography for Detection of Coronary Artery Disease

“…Kinetocardiography recorded sternal movements through the Salerno As in most clinical studies comparing noninvasive test ing to angiography [24], the patient population having angiography was skewed in favor of patients with coro nary disease (79%). Therefore, we increased our normal patient population by inclusion of a low-risk group, as has been proposed by others, although this approach will tend to increase specificity [25], We used qualitative coronary angiography in this study to establish the presence or absence of coronary artery disease. There are problems with the reproducibil ity of this method [26], The use of quantitative angiogra phy will be helpful in future studies but was not available for this study.…”