Abstract
Aim. To compare stress echocardiography and coronary computed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged >70 years.Materials and methods. The study included 390 patients aged >70 years with suspected stable CAD, which underwent elective coronary artery angiography (CAG). Initially, patients for whom stress echocardiography and CCTA is appropriate was determined. After that diagnostic accuracy of both methods in the detection of obstructive CAD was evaluated in patients with atypical angina and non-anginal chest pain.Results. Among 111 patients with atypical angina and non-anginal pain which underwent stress echocardiography and had unequivocal results, 69 (62 %) patients had obstructive CAD. Stress echocardiography has sensitivity of 89%, specificity of 95%, positive likelihood ratio (LR+) of 17,8, and negative likelihood ratio (LR-) of 0,1. Positive result increased probability of obstructive CAD from 62% to 95%, while negative result reduced probability to 16%. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA, 48 (59 %) patients had obstructive CAD. CCTA has sensitivity of 100 %, specificity of 88%, LR+ of 8,3, and LR- of 0,3. Positive result increased post-test probability of obstructive CAD from 59% to 86%, while negative result reduced post-test probability to 0%.Conclusion. Stress echocardiography and CCTA has comparable diagnostic accuracy in the detection of obstructive CAD in patients aged >70 years with atypical angina and non-anginal pain. Stress echocardiography has a greater diagnostic value of positive result; CCTA has a greater diagnostic value of negative result.
Highlights
Тельный результат увеличивал вероятность наличия стенозирующим коронарным атеросклерозом (СКА) с 42% до 86%, отрицательный результат уменьшал вероятность до 0%
На первом этапе была оценена частота обнаружения СКА в зависимости от пола и характера боли в грудной клетке и определен контингент больных, у которых проведение стресс ЭхоКГ и компьютерной томографической ангиографией (КТА) с целью диагностики стабильной ишемической бо лезни сердца (ИБС) является нецелесообразным
How rule-in and rule-out significant coronary artery stenosis in patients with stable angina: to use an article about a diagnostic test
Summary
Among 111 patients with atypical angina and non-anginal pain which underwent stress echocardiography and had unequivocal results, 69 (62 %) patients had obstructive CAD. В.* — аспирант отдела, ORCID: 00000003-4700-9566, Шитов В. М.н., профессор, академик РАН, руководитель отдела томографии, ORCID: 0000-0003-4374-1063]. Ишемическая болезнь сердца of obstructive CAD from 59% to 86%, while negative result reduced post-test probability to 0%. Stress echocardiography and CCTA has comparable diagnostic accuracy in the detection of obstructive CAD in patients aged ≥70 years with atypical angina and non-anginal pain. Из методов визуализации при нагрузке стресс-эхокардиография (стресс-ЭхоКГ) с физической нагрузкой (ФН) является наиболее привлекательным методом диагностики стенозирующего коронарного атеросклероза (СКА) у пациентов старших возрастных категорий. Исследования, касающиеся оценки точности стресс-ЭхоКГ с ФН и КТА в диагностике стабиль ной ИБС у пациентов старших возрастных кат егорий, малочисленны. Целью настоящего исследования явилось сопоставление значимости рез ультатов стресс-ЭхоКГ с ФН и КТА в диагностике стабильной ИБС у пациентов ≥70 лет
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