Detrano R, Lyons K P, Marcondes G, Abbassi N, Froelicher V F, Janosi A
Long Beach Veterans Administration Medical Center, CA 90822.
Arch Intern Med. 1988 Jun;148(6):1289-95.
To evaluate the comparative effects of methodologic factors on the reported accuracies of two standard exercise tests, 56 publications comparing the exercise thallium scintigram with the coronary angiogram were analyzed for conformation to five methodologic standards. Analyzed were adequate definition of study group, avoidance of a limited challenge group, avoidance of workup bias, and blinded analysis of the coronary angiogram and myocardial scintigram. Study group characteristics and technical factors were also reviewed. Better conformation with methodologic standards was found than has been reported previously for treadmill exercise testing. Furthermore, study group characteristics and technical factors were better predictors of sensitivity and specificity than were methodologic deficiencies. Only workup bias and test blinding were significantly associated with test accuracy. The percentage of patients with previous myocardial infarction had the highest correlation and was independently and directly related to sensitivity and inversely related to specificity.
为评估方法学因素对两种标准运动试验报告准确性的比较影响，对56篇比较运动心肌灌注闪烁显像与冠状动脉造影的出版物进行分析，以确定其是否符合五项方法学标准。分析内容包括研究组的充分定义、避免有限挑战组、避免检查偏倚以及冠状动脉造影和心肌闪烁显像的盲法分析。还对研究组特征和技术因素进行了审查。结果发现，与先前报道的平板运动试验相比，该研究与方法学标准的符合度更高。此外，研究组特征和技术因素比方法学缺陷更能预测敏感性和特异性。只有检查偏倚和试验盲法与试验准确性显著相关。既往有心肌梗死患者的比例相关性最高，且与敏感性呈独立直接相关，与特异性呈负相关。
