Hlatky M A, Pryor D B, Harrell F E, Califf R M, Mark D B, Rosati R A
Am J Med. 1984 Jul;77(1):64-71. doi: 10.1016/0002-9343(84)90437-6.
Unlike the predictive value of a diagnostic test, which depends on the prevalence of disease in the population tested, its sensitivity and specificity have been assumed to be constants. This assumption was examined in patients who had both exercise electrocardiography and cardiac catheterization. The effects on sensitivity of factors from clinical history, catheterization, and exercise performance were defined by multivariable logistic regression analysis in 1,401 patients with coronary disease; effects on specificity were defined by a similar analysis in 868 patients without coronary disease. Five factors had significant, independent effects on exercise electrocardiographic sensitivity: maximal exercise heart rate, number of diseased coronary arteries, type of angina, and the patient's age and sex. Only maximal exercise heart rate had a significant, independent effect on exercise electrocardiographic specificity. Thus, the sensitivity and specificity of exercise electrocardiography vary with clinical history, extent of disease, and treadmill performance; the sensitivity and specificity of other diagnostic tests may also vary.
与诊断试验的预测价值不同（其取决于所检测人群中的疾病患病率），人们一直认为其敏感性和特异性是恒定不变的。在同时进行运动心电图检查和心导管检查的患者中对这一假设进行了检验。通过对1401例冠心病患者进行多变量逻辑回归分析，确定了临床病史、心导管检查和运动表现等因素对敏感性的影响；通过对868例无冠心病患者进行类似分析，确定了对特异性的影响。有五个因素对运动心电图敏感性有显著的独立影响：最大运动心率、病变冠状动脉的数量、心绞痛类型以及患者的年龄和性别。只有最大运动心率对运动心电图特异性有显著的独立影响。因此，运动心电图的敏感性和特异性会因临床病史、疾病程度和跑步机运动表现而有所不同；其他诊断试验的敏感性和特异性也可能会有所不同。
