Assessment of Non-Invasive Diagnostic Imaging Modalities Efficiency for Detecting Myocardial Ischemia in Patients Suspected of Having Stable Angina

Abstract

Purpose: This study aimed to assess and compare the detection efficiency of non-invasive diagnostic imaging modalities as easy-to-understand indices for patients with myocardial ischemia. Methods: We included 1,000 patients with chest pain and possible coronary artery disease (CAD), based on their clinical condition. The modalities to be assessed were as follows: cardiac magnetic resonance imaging (CMRI), single-photon emission computed tomography, positron emission computed tomography (PET), stress echocardiography (SE), and fractional flow reserve derived from coronary computed tomography angiography (FFRCT). We used the decision tree simulation analysis to assess and compare the following: (1) the number of true positive (TP), false positive (FP), false negative (FN), and true negative (TN) test results per 1,000 patients, (2) positive predictive value (PPV), (3) negative predictive value (NPV), (4) post-test probability (post-TP), (5) diagnostic accuracy (DA), and (6) the number needed to diagnose (NND). Results: In the basic settings (pre-test probability: 50%), PET generated the highest TP (450), NPV (89%, 95% confidence interval [CI]: 86%-92%), DA (87%, 95% CI: 85%-89%), and NND (1.35, 95% CI: 1.26-1.48). In contrast, CMRI produced the highest TN (435), PPV (87%, 95% CI: 84%-90%), DA (87%, 95% CI: 85%-89%), and NND (1.35, 95% CI: 1.26-1.48). In addition, FFRCT generated the highest FP (120). SE produced the highest FN (155) and post-TP (29%, 95% CI: 25%-33%). Conclusion: PET and CMRI were considered more efficient than other modalities. The results of our study will be useful for both physicians who order the examination and patients who undergo it.