Alencar José Nunes de, Rassi Fabio Mahamad, Rios Raquel Pereira, Scheffer Matheus Kiszka, Carvalho Guilherme Dagostin de
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.
Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2025 Apr;122(4):e20240663. doi: 10.36660/abc.20240663.
Wolff-Parkinson-White (WPW) syndrome is characterized by ventricular pre-excitation, which can lead to severe arrhythmic events such as supraventricular tachycardia and pre-excited atrial fibrillation. The diagnostic value of non-invasive exercise tests in detecting high-risk accessory pathways remains inconsistent in the literature.
To evaluate the diagnostic accuracy of non-invasive exercise tests compared to invasive electrophysiological studies (EPS) for identifying high-risk accessory pathways in WPW syndrome.
Following PRISMA-DTA guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science databases. Eligible studies assessed the sensitivity, specificity, and likelihood ratios of non-invasive exercise tests in WPW patients, using EPS as the reference standard. A bivariate random-effects model was applied for meta-analysis.
Six studies, comprising a total of 765 patients, met the inclusion criteria. The pooled sensitivity was 92.7% (95% CI: 88.0% - 94.0%), while the pooled specificity was 28.1% (95% CI: 23% - 35.1%). A negative likelihood ratio (LR-) of 0.260 (95% CI: 0.174 - 0.387) indicated that the presence of a high-risk accessory pathway is about four times less likely after a negative test result. Sensitivity analysis restricted to pediatric patients showed consistent results.
Non-invasive exercise tests demonstrate a reasonable diagnostic utility for ruling out high-risk pathways in WPW syndrome. However, caution is advised when using these tests as standalone criteria for risk stratification.
预激综合征（WPW）的特征是心室预激，可导致严重的心律失常事件，如室上性心动过速和预激性心房颤动。无创运动试验在检测高危旁路方面的诊断价值在文献中仍不一致。
评估无创运动试验与有创电生理研究（EPS）相比，用于识别WPW综合征高危旁路的诊断准确性。
按照PRISMA-DTA指南，在PubMed、Scopus和Web of Science数据库中进行全面检索。符合条件的研究以EPS作为参考标准，评估WPW患者无创运动试验的敏感性、特异性和似然比。采用双变量随机效应模型进行荟萃分析。
六项研究共纳入765例患者，符合纳入标准。合并敏感性为92.7%（95%CI：88.0% - 94.0%），合并特异性为28.1%（95%CI：23% - 35.1%）。阴性似然比（LR-）为0.260（95%CI：0.174 - 0.387），表明检测结果为阴性后，存在高危旁路的可能性降低约四倍。限于儿科患者的敏感性分析显示结果一致。
无创运动试验在排除WPW综合征高危旁路方面显示出合理的诊断效用。然而，将这些试验用作风险分层的独立标准时需谨慎。
