Kwok Y, Kim C, Grady D, Segal M, Redberg R
Department of Medicine, University of California, San Francisco, USA.
Am J Cardiol. 1999 Mar 1;83(5):660-6. doi: 10.1016/s0002-9149(98)00963-1.
To determine the accuracy of the exercise electrocardiogram (ECG), exercise thallium, and exercise echocardiogram (echo) for the diagnosis of coronary artery disease in women, English language studies published between 1966 and 1995 were identified through a MEDLINE search. Studies that contained data on at least 50 women who underwent both an exercise test and coronary angiography were examined. Studies were reviewed for sensitivity, specificity, and methodologic characteristics by 2 independent reviewers. Nineteen studies met the inclusion criteria for exercise electrocardiography, 5 studies for exercise thallium, and 3 studies for exercise echo. The exercise ECG had a weighted mean sensitivity, specificity, and a likelihood ratio (LR) of 0.61 (95% confidence intervals 0.54 to 0.68), 0.70 (0.64 to 0.75), (+) LR 2.25 (1.84 to 2.66), (-) LR 0.55 (0.47 to 0.62), respectively. The exercise thallium had a weighted mean sensitivity, specificity, and LRs of 0.78 (0.72 to 0.83), 0.64 (0.51 to 0.77), (+) LR 2.87 (1.0 to 4.96), (-) LR 0.36 (0.27 to 0.45). The exercise echo had a weighted mean sensitivity, specificity, and LRs of 0.86 (0.75 to 0.96), 0.79 (0.72 to 0.86), (+) LR 4.29 (2.93 to 5.65), (-) LR 0.18 (0.05 to 0.31). Thallium subset analysis revealed that studies using planar imaging were more specific than those using tomographic imaging. Thus, currently available exercise tests are only moderately sensitive and specific for the diagnosis of coronary artery disease in women.
为确定运动心电图（ECG）、运动铊心肌显像及运动超声心动图（超声）诊断女性冠状动脉疾病的准确性，通过医学在线数据库检索了1966年至1995年间发表的英文研究。纳入至少50名接受运动试验及冠状动脉造影检查女性数据的研究。由2名独立评审员对研究的敏感性、特异性及方法学特征进行评估。19项研究符合运动心电图纳入标准，5项符合运动铊心肌显像纳入标准，3项符合运动超声心动图纳入标准。运动心电图加权平均敏感性、特异性及似然比（LR）分别为0.61（95%可信区间0.54至0.68）、0.70（0.64至0.75）、阳性似然比2.25（1.84至2.66）、阴性似然比0.55（0.47至0.62）。运动铊心肌显像加权平均敏感性、特异性及似然比分别为0.78（0.72至0.83）、0.64（0.51至0.77）、阳性似然比2.87（1.0至4.96）、阴性似然比0.36（0.27至0.45）。运动超声心动图加权平均敏感性、特异性及似然比分别为0.86（0.75至0.96）、0.79（0.72至0.86）、阳性似然比4.29（2.93至5.65）、阴性似然比0.18（0.05至0.31）。铊心肌显像亚组分析显示，使用平面显像的研究比使用断层显像的研究特异性更高。因此，目前可用的运动试验诊断女性冠状动脉疾病的敏感性和特异性仅为中等水平。
