The diagnostic accuracy of the exercise electrocardiogram: A meta-analysis of 22 years of research

Detrano, Robert; Gianrossi, R; Froelicher, Victor F.

doi:10.1016/0033-0620(89)90025-x

Cited by 158 publications

(71 citation statements)

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“…Examples are the exclusion of patients using beta-blockers in studies of exercise electrocardiography and the exclusion of patients with pre-existing pulmonary diseases in studies of ventilation-perfusion scintigraphy (24,25 ).…”

Section: Methods) (22 )mentioning

confidence: 99%

“…Nor does every pathologist render the same diagnosis from a given set of tissue sections (35 (36 ) Authors should describe the methods involved in the execution of index test and reference standard in sufficient detail to allow other researchers to replicate the study or to allow readers to judge the feasibility of the index test in their own setting. Differences in the execution of the index test and reference standard are a potential source of variation in diagnostic accuracy (13,24 ).…”

Section: Patients Were Prospectively Enrolled During Times the Investmentioning

confidence: 99%

“…If no descriptions are available, details must be provided in the text. Between-study variability in measures of test accuracy due to differences in test protocol has been documented for a number of tests, including the use of hyperventilation before exercise electrocardiography and the use of tomography for exercise thallium scintigraphy (23,24 ). item 9. describe definition of and rationale for the units, cutoffs and/or categories of the results of the index tests and the reference standard.…”

Section: Patients Were Prospectively Enrolled During Times the Investmentioning

confidence: 99%

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The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration

et al. 2003

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The quality of reporting of studies of diagnostic accuracy is less than optimal. Complete and accurate reporting is necessary to enable readers to assess the potential for bias in the study and to evaluate the generalisability of the results.A group of scientists and editors has developed the STARD (Standards for Reporting of Diagnostic Accuracy) statement to improve the reporting the quality of reporting of studies of diagnostic accuracy. The statement consists of a checklist of 25 items and flow diagram that authors can use to ensure that all relevant information is present.This explanatory document aims to facilitate the use, understanding and dissemination of the checklist. The document contains a clarification of the meaning, rationale and optimal use of each item on the checklist, as well as a short summary of the available evidence on bias and applicability.The STARD statement, checklist, flowchart and this explanation and elaboration document should be useful resources to improve reporting of diagnostic accuracy studies. Complete and informative reporting can only lead to better decisions in healthcare.

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Section: Methods) (22 )mentioning

confidence: 99%

Section: Patients Were Prospectively Enrolled During Times the Investmentioning

confidence: 99%

Section: Patients Were Prospectively Enrolled During Times the Investmentioning

confidence: 99%

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The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration

et al. 2003

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“…A maioria dos estudos realizados [8][9][10][11] demonstra sensibilidade entre 50 e 72% (média de 67%) e especificidade entre 69 e 74% (média de 71%). É importante, no entanto, ressaltar as limitações desses valores uma vez que o padrão-ouro de comparação é a cineangiocoronariografia que analisa apenas anatomia da árvore arterial coronariana.…”

Section: I212 -Sensibilidade Especificidade E Valor Preditivounclassified

<![CDATA[<B>II Diretrizes da Sociedade Brasileira de Cardiologia</B> <B>Sobre Teste Ergom�trico</B>]]>

Andrade¹,

Brito²,

Castro³

et al. 2002

Arq. Bras. Cardiol.

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“…5) Meta-analysis of 147 consecutively published studies involving 24,074 patients who underwent both standard exercise testing and coronary angiography revealed a wide variability and modest acceptability in sensitivity and specificity (mean sensitivity was 68%, with a standard deviation of 16%; mean specificity was 77%, with a standard deviation of 17%). 6,7) Although the modest sensitivity of exercise electrocardiography is generally less than the sensitivity of imaging procedures, such as single-photon emission computed tomography imaging of myocardial perfusion and positronemission tomography, 8) exercise testing is still widely available and relatively low-cost. The interpretation of exercise test results for diagnostic and prognostic purposes requires consideration of maximal work capacity.…”

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confidence: 99%

Cardiac Autonomic Functions Derived From Short-Term Heart Rate Variability Recordings Associated With Nondiagnostic Results of Treadmill Exercise Testing

et al. 2010

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SummaryAnalysis of short-term (5-minute) heart rate variability (HRV) may provide useful information about autonomic nervous control of the cardiovascular system. The aim of the present study was to evaluate the association between the results of treadmill exercise testing (TET) and short-term (5-minute) HRV. Patients undertaking TET were anteriorly evaluated with short-term (5-minute) HRV over time (SDNN, RMSSD, NN50 count, pNN50) and frequency (LF, HF, total power) domains. Among 414 patients, 32 individuals (7.7%; 14 men) had nondiagnostic results. The nondiagnostic group had older age, higher body mass index, more hypertension, lower SDNN, lower LF, and higher HF than the negative group. After adjustment for potential confounders, SDNN (OR 0.94, 95% CI 0.91-0.97; P = 0.01), RMSSD (OR 0.96, 95% CI 0.93-0.99; P = 0.02), NN50 count (OR 0.98, 95% CI 0.97-1.00; P = 0.04) and LF (OR 0.96, 95% CI 0.96-0.99; P = 0.03) were negatively related to nondiagnostic results, and HF showed a positive effect (OR 1.04, 95% CI 1.01-1.05; P = 0.02). No HRV indices were significantly associated with positive results. Our study suggested that cardiac autonomic indices derived from short-term HRV recordings might predict nondiagnostic results of TET. (Int Heart J 2010; 51: 105-110) Key words: Heart rate variability, Treadmill exercise test, Nondiagnostic H eart rate variability (HRV) represents one of the most promising quantitative markers of autonomic activity. 1) HRV in the time and frequency domains is a noninvasive, convenient tool for evaluation of autonomic nervous physiology.2) Time domain analysis estimates the variation of differences between successive RR intervals through indices developed by statistical methods. Frequency domain analysis estimates respiratory-dependent high frequency and low frequency power through spectral analysis. High frequency power is considered to be mediated mainly by vagal activity, while low frequency power has been suggested as predominantly sympathetic modulation.3,4) The most commonly used frequency domains include LF, low frequency power; HF, high frequency power; and total power. Short-term (5-minute) recording is a reliable tool to obtain these HRV measures. 2)Exercise electrocardiography is one of the most frequent noninvasive modalities used to assess patients with suspected or proven cardiovascular disease.5) Meta-analysis of 147 consecutively published studies involving 24,074 patients who underwent both standard exercise testing and coronary angiography revealed a wide variability and modest acceptability in sensitivity and specificity (mean sensitivity was 68%, with a standard deviation of 16%; mean specificity was 77%, with a standard deviation of 17%). 6,7)Although the modest sensitivity of exercise electrocardiography is generally less than the sensitivity of imaging procedures, such as single-photon emission computed tomography imaging of myocardial perfusion and positronemission tomography, 8) exercise testing is still widely available and relatively low-cost. The interpr...

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The diagnostic accuracy of the exercise electrocardiogram: A meta-analysis of 22 years of research

Cited by 158 publications

References 159 publications

The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration

The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration

<![CDATA[<B>II Diretrizes da Sociedade Brasileira de Cardiologia</B> <B>Sobre Teste Ergom�trico</B>]]>

Cardiac Autonomic Functions Derived From Short-Term Heart Rate Variability Recordings Associated With Nondiagnostic Results of Treadmill Exercise Testing

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