SPECKLE TRACKING DOBUTAMINE STRESS ECHOCARDIOGRAPHY DIAGNOSTIC ACCURACY IN PRIMARY CORONARY ARTERIES DISEASE DIAGNOSIS

2020 ◽  
Vol 73 (11) ◽  
pp. 2447-2456
Author(s):  
Vladyslav A. Smiianov ◽  
Serhii A. Rudenko ◽  
Serhii.V. Potashev ◽  
Serhii V. Salo ◽  
Andrii Y. Gavrylyshin ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Coronary Arteries ◽  
Myocardial Viability ◽  
False Negative ◽  
Disease Diagnosis ◽  
Lower Sensitivity ◽  
Low Grade ◽  
Visualization Method ◽  
Coronary Reserve ◽  
Test Result

The aim of the work was to evaluate STE feasibility as DSE visualization method and its accuracy compared to coronary angiography (CAG) in the patients with moderate-tohigh coronary arteries disease (CAD) risk. Materials and methods: We prospectively examined 140 pts (84 (60.0%) men) with suspected CAD in order to verify diagnosis and evaluate myocardial viability and coronary reserve. Results: Mean LV EF was 54.4±15.8%. All pts had normal BP and HR during the test. There were no significant hemodynamics alterations during the test. There were no significant complications during DSE – 15 (12.9%) cases of different relatively low-grade supraventricular and ventricular arrhythmia, mainly transitory without interventions. There were 116 (82.9%) positive DSE results, of which 2 (1.72%) were false-positive. In 2 (8.3%) pts with negative DSE results CAG revealed 1-vessel insignificant (50 – 70%) lesions with developed collaterals (false-negative results). According to DSE and CAG results, 96 (82.3%) pts underwent revascularization interventions – 86 (89.6%) PCI’s and (10.4%) CABG surgeries. Sensitivity and specificity of DSE with STE for primary CAD diagnosis according to “golden standard” CAG results were 98.3% and 91.7%, respectively, with identical positive and negative predictive value and very high method overall accuracy (AUC = 0.98) and OR = 627.0 (p<0.0001). Sensitivity and specificity of DSE with STE for defining indications for intervention and revascularization were 97.9% and 91.7%, respectively, with high overall accuracy (AUC = 0.95; OR = 564.0, p<0.0001). Combined quantification of ΔGLS and ΔWMSI for primary CAD diagnosis showed significantly lower sensitivity 86.2% (р=0.0002) and specificity 80.4% (р=0.0064) with significantly lower integral method accuracy (AUC 0.83, р<0.0001). Conclusions: DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis and myocardial viability and coronary reserve evaluation in the pts with CAD suspicion. Given the lower ΔGLS and ΔWMSI accuracy compared to integral DSE with STE result evaluation, as well as frequent GLS growth in significant amount of patients with definite positive test result, authors recommend evaluating integral test result rather than strain value.

scholarly journals Longitudinal Strain by Speckle Tracking during Dobutamine Stress Echocardiography in Suspected Coronary Arteries Disease

2020 ◽  
pp. 15-25
Author(s):  
S. V. Potashev ◽  
S. V. Salo ◽  
A. Y. Gavrylyshyn ◽  
L. M. Hrubyak ◽  
O. M. Unitska ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Coronary Arteries ◽  
Myocardial Viability ◽  
Speckle Tracking ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Visualization Method ◽  
Coronary Reserve ◽  
Test Result

  Background. Speckle tracking echocardiography (STE) provides valuable information about global and regional myocardial function. STE during dobutamine stress-echocardiography (DSE) enables more reliable ischemia diagnosis. The aim of the study was to evaluate STE feasibility as a DSE visualization method and its accuracy compared to coronary angiography (CAG) in the patients with moderate-to-high coronary arteries disease (CAD) risk. Methods. We prospectively examined 140 patients (84 [60.0%] men and 56 [40.0%] women) with suspected CAD in order to verify diagnosis and evaluate myocardial viability and coronary reserve. Results. Mean left ventricular ejection fraction (LVEF) was 54.4±15.8%. All the patients had normal blood pressure (BP) and heart rate (HR) during the test. There were no significant hemodynamics alterations during the test. There were no significant complications during DSE with only 15 (12.9%) cases of different relatively low grade supraventricular and ventricular arrhythmia, mainly transitory without interventions. There were 116 (82.9%) positive DSE results, of which 2 (1.72%) were false-positive. In 2 (8.3%) patients with negative DSE results, CAG revealed 1-vessel insignificant (50– 70%) lesions with developed collaterals (false-negative results). According to DSE and CAG results, 96 (82.3%) patients underwent revascularization interventions: 86 (89.6%) percutaneous coronary interventions (PCIs) and 10 (10.4%) coronary artery bypass grafting (CABG) surgery. Sensitivity and specificity of DSE with STE for primary CAD diagnosis according to the “golden standard” CAG results were 98.3% and 91.7%, respectively, with identical positive and negative predictive values and very high overall accuracy of the method (AUC = 0.98; OR = 627.0, p<0.0001). Sensitivity and specificity of DSE with STE for defining indications for intervention and revascularization were 97.9% and 91.7%, respectively, with high overall accuracy (AUC = 0.95; OR = 564.0, p<0.0001). Combined quantification of ΔGLS and ΔWMSI for primary CAD diagnosis showed significantly lower sensitivity 86.2%(p=0.0002)andspecificity80.4%(p=0.0064)withsignificantlylowerintegralmethodaccuracy(AUC0.83,p<0.0001). Conclusions. DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis and evaluation of myocardial viability and coronary reserve in patients with suspected CAD. Given the lower ΔGLS and ΔWMSI accuracy compared to integral DSE with STE result evaluation, as well as frequent GLS growth in significant number of patients with definite positive test result, authors recommend evaluating integral test result rather than strain value.

scholarly journals Dobutamine Stress Echocardiography with B-Mode Speckle Tracking in Patients after Acute Coronary Syndromes: Diagnostic and Prognostic Value

2020 ◽  
pp. 28-37
Author(s):  
S. V. Potashev ◽  
S. V. Salo ◽  
A. Y. Gavrylyshyn ◽  
S. A. Rudenko ◽  
O. M. Holtvian
Keyword(s):  
Coronary Artery ◽  
Myocardial Viability ◽  
Speckle Tracking ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Low Grade ◽  
Coronary Reserve

  Background. Speckle tracking echocardiography (STE) provides valuable data on myocardial function. STE during dobutamine stress echocardiography (DSE) allows reliable myocardial ischemia diagnosis. Aim. To evaluate STE during DSE in patients with coronary artery disease (CAD) after acute coronary syndrome (ACS) and its accuracy in ischemia diagnosis, assessment of myocardial viability and coronary reserve. Methods. We examined 58 patients (55 [94,8 %] men and 3 [5,2 %] women) men) with CAD after ACS admitted to our Institute for defining indications for coronary interventions. All the patients underwent DSE with STE for longitudinal strain quantification. Results. Mean left ventricular ejection fraction (LVEF) was 52.4±5.8%. Significant CAD according to coronary angiography (CAG) prior to DSE was proved in 38 (65.5%) patients. All the patients had a history of ACS up to 12 years before the examination (38 [65.5%] patients after percutaneous coronary intervention (PCI), including 18 [31.0%] primary PCI; 9 [15.5%] patients after coronary artery bypass grafting (CABG); 3 [5.2%] after graft PCI, 1 [1.72%] patient after aortic valve replacement (AVR) with dilated cardiomyopathy (DCM) phenotype). There were no significant complications during DSE: 5 (8.6%) cases of relatively low grade transient arrhythmia with no need for intervention. As per DSE results, we performed 35 (60.3%) revascularization interventions: 31 (58.6%) PCI’s and 4 (6.9%) CABG procedures with good outcomes. It was shown that DSE with STE sensitivity and specificity were 89.7% and 94.7% (AUC 0.92), respectively, with positive and negative predictive values of 97.2% and 81.8%, respectively, with extremely high OR 157.5, p<0.0001. Combined quantification of ΔGLS and ΔWMSI showed insignificantly lower sensitivity (86.3% [p=0.57]) and specificity (87.8% [p=0.19]) vs. integral semiquantitative ischemia markers with significantly lower overall method accuracy (AUC 0.79, p=0.047). Conclusions. DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis, as well as for myocardial viability and coronary reserve assessment in patients with CAD after ACS with the aim of risk stratification and defining indications for interventions and myocardial revascularization.

How to Correct for Chance Agreement in the Estimation of Sensitivity and Specificity of Diagnostic Tests

1994 ◽  
Vol 33 (02) ◽  
pp. 180-186 ◽  
Author(s):  
H. Brenner ◽  
O. Gefeller
Keyword(s):  
Sensitivity And Specificity ◽  
Disease Status ◽  
Disease Prevalence ◽  
Small Sample ◽  
Small Samples ◽  
Interval Estimate ◽  
Traditional Concept ◽  
Interval Estimates ◽  
Major Disadvantage ◽  
Test Result

Abstract:The traditional concept of describing the validity of a diagnostic test neglects the presence of chance agreement between test result and true (disease) status. Sensitivity and specificity, as the fundamental measures of validity, can thus only be considered in conjunction with each other to provide an appropriate basis for the evaluation of the capacity of the test to discriminate truly diseased from truly undiseased subjects. In this paper, chance-corrected analogues of sensitivity and specificity are presented as supplemental measures of validity, which pay attention to the problem of chance agreement and offer the opportunity to be interpreted separately. While recent proposals of chance-correction techniques, suggested by several authors in this context, lead to measures which are dependent on disease prevalence, our method does not share this major disadvantage. We discuss the extension of the conventional ROC-curve approach to chance-corrected measures of sensitivity and specificity. Furthermore, point and asymptotic interval estimates of the parameters of interest are derived under different sampling frameworks for validation studies. The small sample behavior of the estimates is investigated in a simulation study, leading to a logarithmic modification of the interval estimate in order to hold the nominal confidence level for small samples.

CURRENT ASPECTS OF CORONARY HEART DISEASE DIAGNOSIS AND TREATMENT

2020 ◽  
pp. 5-10
Author(s):  
O. M. Korzh
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Drug Therapy ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Disease Diagnosis ◽  
Percutaneous Coronary Angioplasty ◽  
Mortality And Morbidity ◽  
Intravascular Thrombosis

Among the cardiovascular diseases associated with atherosclerosis, chronic coronary heart disease, including angina, is the most common form. It is the myocardium lesion that develops as a result of an imbalance between the coronary circulation and metabolic needs of heart muscle. The presence of angina symptoms often indicates a pronounced narrowing of one or more coronary arteries, but also occurs in non−obstructive arterial impairment and even in normal coronary arteries. Factors of functional damage to the coronary arteries are spasm, temporary platelet aggregation and intravascular thrombosis. Today there are opportunities not only to use the therapy with proven effectiveness, aimed at reducing the risk of complications, including fatal, but also to treat angina (ischemia), which improves the patient's life quality. The drug protocol includes the ones with a proven positive effect on this disease prognosis, which are mandatory if there are no direct contraindications to use, as well as a large group of antianginal or anti−ischemic drugs. The choice of a particular drug or its combinations with other drugs is carried out in accordance with generally accepted recommendations: taking into account the individual approach, the severity of angina, hemodynamic parameters (heart rate and blood pressure, presence of comorbid conditions). If drug therapy is ineffective, the option of coronary myocardial revascularization (percutaneous coronary angioplasty or coronary artery bypass grafting) is considered. Due to the high mortality and morbidity rates of coronary heart disease worldwide, one of the priorities of practical health care is the prevention of diseases caused by atherosclerosis. Key words: coronary heart disease, angina, family physician, prognosis, drug therapy.

scholarly journals Pretherapeutic Imaging for Axillary Staging in Breast Cancer: A Systematic Review and Meta-Analysis of Ultrasound, MRI and FDG PET

2021 ◽  
Vol 10 (7) ◽  
pp. 1543
Author(s):  
Morwenn Le Boulc’h ◽  
Julia Gilhodes ◽  
Zara Steinmeyer ◽  
Sébastien Molière ◽  
Carole Mathelin
Keyword(s):  
Systematic Review ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
False Negative ◽  
Significant Proportion ◽  
False Negative Rate ◽  
True Positive Rate ◽  
Axillary Staging ◽  
Positron Emission ◽  
Positive Rate

Background: This systematic review aimed at comparing performances of ultrasonography (US), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (PET) for axillary staging, with a focus on micro- or micrometastases. Methods: A search for relevant studies published between January 2002 and March 2018 was conducted in MEDLINE database. Study quality was assessed using the QUality Assessment of Diagnostic Accuracy Studies checklist. Sensitivity and specificity were meta-analyzed using a bivariate random effects approach; Results: Across 62 studies (n = 10,374 patients), sensitivity and specificity to detect metastatic ALN were, respectively, 51% (95% CI: 43–59%) and 100% (95% CI: 99–100%) for US, 83% (95% CI: 72–91%) and 85% (95% CI: 72–92%) for MRI, and 49% (95% CI: 39–59%) and 94% (95% CI: 91–96%) for PET. Interestingly, US detects a significant proportion of macrometastases (false negative rate was 0.28 (0.22, 0.34) for more than 2 metastatic ALN and 0.96 (0.86, 0.99) for micrometastases). In contrast, PET tends to detect a significant proportion of micrometastases (true positive rate = 0.41 (0.29, 0.54)). Data are not available for MRI. Conclusions: In comparison with MRI and PET Fluorodeoxyglucose (FDG), US is an effective technique for axillary triage, especially to detect high metastatic burden without upstaging majority of micrometastases.

scholarly journals Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

2021 ◽  
Vol 07 (03) ◽  
pp. e132-e137
Author(s):  
Mohammed Alagha ◽  
Thomas M. Aherne ◽  
Ahmed Hassanin ◽  
Adeel S. Zafar ◽  
Doireann P. Joyce ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Sensitivity And Specificity ◽  
False Negative ◽  
Arterial Disease ◽  
Initial Assessment ◽  
Reference Standard ◽  
Lower Extremity Arterial Disease ◽  
Negative Results ◽  
Positive Results ◽  
Arterial Imaging

Abstract Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark. Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard. Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively. Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.

scholarly journals Evaluation of Recombinant Proteins of Burkholderia mallei for Serodiagnosis of Glanders

2012 ◽  
Vol 19 (8) ◽  
pp. 1193-1198 ◽  
Author(s):  
Vijai Pal ◽  
Subodh Kumar ◽  
Praveen Malik ◽  
Ganga Prasad Rai
Keyword(s):  
Sensitivity And Specificity ◽  
Recombinant Proteins ◽  
False Negative ◽  
Enzyme Linked Immunosorbent Assay ◽  
Burkholderia Mallei ◽  
Content Type ◽  
Whole Cells ◽  
Negative Results ◽  
Elisa Format ◽  
Low Sensitivity

ABSTRACTGlanders is a contagious disease caused by the Gram-negative bacillusBurkholderia mallei. The number of equine glanders outbreaks has increased steadily during the last decade. The disease must be reported to the Office International des Epizooties, Paris, France. Glanders serodiagnosis is hampered by the considerable number of false positives and negatives of the internationally prescribed tests. The major problem leading to the low sensitivity and specificity of the complement fixation test (CFT) and enzyme-linked immunosorbent assay (ELISA) has been linked to the test antigens currently used, i.e., crude preparations of whole cells. False-positive results obtained from other diagnostic tests utilizing crude antigens lead to financial losses to animal owners, and false-negative results can turn a risk into a possible threat. In this study, we report on the identification of diagnostic targets using bioinformatics tools for serodiagnosis of glanders. The identified gene sequences were cloned and expressed as recombinant proteins. The purified recombinant proteins ofB. malleiwere used in an indirect ELISA format for serodiagnosis of glanders. Two recombinant proteins, 0375H and 0375TH, exhibited 100% sensitivity and specificity for glanders diagnosis. The proteins also did not cross-react with sera from patients with the closely related disease melioidosis. The results of this investigation highlight the potential of recombinant 0375H and 0375TH proteins in specific and sensitive diagnosis of glanders.

Pitfalls in Salivary Gland Fine-Needle Aspiration Cytology: Lessons From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology

2005 ◽  
Vol 129 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Jonathan H. Hughes ◽  
Emily E. Volk ◽  
David C. Wilbur
Keyword(s):  
Salivary Gland ◽  
Fine Needle Aspiration ◽  
False Positive ◽  
Interlaboratory Comparison ◽  
False Negative ◽  
Diagnostic Errors ◽  
Poor Performance ◽  
Needle Aspiration ◽  
Low Grade ◽  
Fine Needle

Abstract Context.—We use data from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology to identify common diagnostic errors in salivary gland fine-needle aspiration (FNA). Objective.—To identify salivary gland FNA cases with poor performance characteristics in the Nongynecologic Cytology Program surveys, so that the most common diagnostic pitfalls can be avoided. Design.—A retrospective review of the College of American Pathologists Nongynecologic Cytology Program's cumulative data from 1999 to 2003 revealed the most common false-positive and false-negative interpretations on FNA for common salivary gland lesions. Slides that performed poorly were then reviewed to identify the cytologic characteristics that may have contributed to their poor performance. Results.—A total of 6249 participant responses with general interpretations of benign (n = 4642) or malignant (n= 1607) were reviewed. The sensitivity and specificity of the participant responses for correctly interpreting the cases as benign or malignant were 73% and 91%, respectively. Benign cases with the highest false-positive rates were monomorphic adenoma (53% false-positive), intraparotid lymph node (36%), oncocytoma (18%), and granulomatous sialadenitis (10%). Malignant cases with the highest false-negative rates were lymphoma (57%), acinic cell carcinoma (49%), low-grade mucoepidermoid carcinoma (43%), and adenoid cystic carcinoma (33%). Selected review of the most discordant individual cases revealed possible explanations for some of the interpretative errors. Conclusions.—These data confirm the difficulty associated with interpretation of salivary gland FNA specimens. Cytologists should be aware of the potential false-positive and false-negative interpretations that can occur in FNAs from this organ site in order to minimize the possibility of diagnostic errors.

AEC Classifier: A Tree-Based Classifier with Error Control for Medical Disease Diagnosis and Other Applications

2021 ◽  
Vol 15 (02) ◽  
pp. 241-262
Author(s):  
Wasif Bokhari ◽  
Ajay Bansal
Keyword(s):  
Error Control ◽  
Binary Classification ◽  
False Negative ◽  
Disease Diagnosis ◽  
False Negatives ◽  
Medical Disease ◽  
Unique Nature ◽  
Comparable Accuracy ◽  
The Cost ◽  
Roc Score

In medical disease diagnosis, the cost of a false negative could greatly outweigh the cost of a false positive. This is because the former could cost a life, whereas the latter may only cause medical costs and stress to the patient. The unique nature of this problem highlights the need of asymmetric error control for binary classification applications. In this domain, traditional machine learning classifiers may not be ideal as they do not provide a way to control the number of false negatives below a certain threshold. This paper proposes a novel tree-based binary classification algorithm that can control the number of false negatives with a mathematical guarantee, based on Neyman–Pearson (NP) Lemma. This classifier is evaluated on the data obtained from different heart studies and it predicts the risk of cardiac disease, not only with comparable accuracy and AUC-ROC score but also with full control over the number of false negatives. The methodology used to construct this classifier can be expanded to many more use cases, not only in medical disease diagnosis but also beyond as shown from analysis on different diverse datasets.

Abstract 5697: Echocardiographic Detected Hibernating Myocardium Can Predict Arrhythmic Events in Patients with Ischemic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ken Matsuoka ◽  
Masami Nishino ◽  
Daisuke Nakamura ◽  
Takahiro Yoshimura ◽  
Yasuharu Ri ◽  
...  
Keyword(s):  
Myocardial Viability ◽  
Cardiac Death ◽  
Ischemic Cardiomyopathy ◽  
Coronary Revascularization ◽  
Nuclear Imaging ◽  
Left Ventricular ◽  
Hibernating Myocardium ◽  
Low Grade ◽  
Regional Dysfunction

Backgrounds: In medically treated patients with ischemic cardiomyopathy, myocardial viability is associated with a worse prognosis than scar. Hibernating myocardium (chronic regional dysfunction with reduced resting flow) assessed with nuclear imaging is a major risk factor for cardiac death when left ventricular function is depressed. End-diastolic wall thickness (EDWT) is an important and easy marker of myocardial viability in patients with suspected hibernation, as well as Tl-201 scintigraphy. Thus, in this study, we assessed whether hibernating myocardium evaluated by echocardiography could identify patients with ischemic cardiomyopathy who are at high risk for sudden cardiac death (SCD) and mortality. Methods: Patients with ischemic cardiomyopathy who showed low-grade cardiac function (ejection fraction (EF) < or =50%) and had no plans for coronary revascularization were enrolled. All patients underwent coronary angiography and echocardiography. Hibernating myocardium was defined as the area with major epicardial artery stenosis > or =75%, wall motion abnormality, and EDWT >6mm. The onset of SCD or mortality was determined by outpatient or telephone follow-up. Results: The study patients consisted of 60 consecutive patients (47 men, EF: 35 ± 8%, follow-up duration: 38 ± 16 months). Results were shown in a figure . Hibernating myocardium significantly increased the risk of SCD and mortality. Conclusion: Hibernating myocardium evaluated by echocardiography can predict SCD and mortality in medically treated patients with ischemic cardiomyopathy. Figure Kalpan-Meler Estimates of the Time to SCD or Mortality

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