Implications of Alterations in Pre-test Probability in the 2019 Update of ESC Guidelines for Chronic Coronary Syndromes on Diagnostic Accuracy of Pharmacological Stress-Echocardiography: A Retrospective Cohort Study

Iryna Dykun; Stefanie Hendricks; Bastian Balcer; Matthias Totzeck; Fadi Al-Rashid; Tienush Rassaf; Amir A. Mahabadi

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자료유형: 학술저널

저자정보: Iryna Dykun (University of Duisburg-Essen) Stefanie Hendricks (University of Duisburg-Essen) Bastian Balcer (University of Duisburg-Essen) Matthias Totzeck (University of Duisburg-Essen) Fadi Al-Rashid (University of Duisburg-Essen) Tienush Rassaf (University of Duisburg-Essen) Amir A. Mahabadi (University of Duisburg-Essen)

저널정보: 한국심초음파학회 Journal of Cardiovascular Imaging Journal of Cardiovascular Imaging 제29권 제2호

발행연도: 2021.1

수록면: 160 - 165 (6page)

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BACKGROUND: With the 2019 update of European Society of Cardiology (ESC) guidelines for chronic coronary syndromes, the pre-test probabilities (PTPs) based on age, sex, and symptoms have undergone major revisions. We aimed to determine implications of these alterations on diagnostic accuracy of dobutamine stress echocardiography (DSE). METHODS: We retrospectively included consecutive patients undergoing pharmacological stress-echocardiography for evaluation of suspected obstructive coronary artery disease. DSE was performed as non-invasive imaging test and was indicated by individual treating physician's decision. Sensitivity, specificity, positive and negative predictive value as well as accuracy were assessed for detection of obstructive coronary artery disease, defined as revascularization therapy following DSE. RESULTS: We included 206 patients (mean age 63.2 ± 12.4 years, 59.7% male). 51% of the cohort had a PTP of < 15% according to both scores. 9.2% of patients with PTP < 15% according to the original Diamond and Forrester score had a PTP > 15% according to 2019 ESC guidelines, predominantly due to the accountancy of dyspnea. In contrast, 13.6% of patient had a PTP ≥ 15% according to the original Diamond and Forrester score, while PTP was assessed below this threshold by updated guidelines. The differences in patient selection according to updated guidelines did not alter the diagnostic accuracy of DSE (68% for both). CONCLUSIONS: Changes in assessment of PTP according to updated ESC guidelines from 2019 led to a relevant reclassification of patients with suspected coronary artery disease, ultimately changing the group of patients appropriate for DSE for evaluation of myocardial ischemia. Comparing the diagnostic performance in appropriate PTP groups, however, led to similar results.

#Stress echocardiography #Pretest probability #Chronic coronary syndrome #Diamond and Forrester

참고문헌 (7)

참고문헌 신청

Diamond GA / 1979 / Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease / N Engl J Med 300:1350~1358

Knuuti J / 2020 / 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes / Eur Heart J 41:407~477

Picano E / 2008 / The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease : a meta-analysis / Cardiovasc Ultrasound 6:30

Heijenbrok-Kal MH / 2007 / Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance / Am Heart J 154:415~423

Pellikka PA / 2020 / Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography / J Am Soc Echocardiogr 33:1~41

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