An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease
Identifieur interne : 001675 ( Main/Corpus ); précédent : 001674; suivant : 001676An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease
Auteurs : P. MoriseSource :
- Journal of Nuclear Cardiology [ 1071-3581 ] ; 1995-05-01.
Abstract
Abstract: Background: The goal was to assess the incremental diagnostic value of thallium single-photon emission computed tomographic (SPECT) imaging and lung/heart ratio (LHR) over other clinical and exercise electrocardiographic (ECG) variables concerning the presence and extent (three vessel/left main) of coronary artery disease. Methods and Results: Multivariable logistic regression analysis that used an incremental study design was applied to clinical, exercise test, SPECT, LHR, and catheterization data from 323 patients with suspected coronary disease. The following variables were evaluated as predictors of presence and extent of disease: clinical (age, sex, symptoms, diabetes, and smoking), exercise ECG (millimeters of ST segment depression, slope of ST segment depression, peak heart rate, change in systolic blood pressure, and metabolic equivalents of the task), and thallium (defect reversibility and intensity of hypoperfusion and LHR). Discrimination and incremental value were assessed by receiver operating characteristic (ROC) curve analysis. SPECT imaging (segment hypoperfusion score) was an independent predictor of both presence and extent of disease (p<0.0001) irrespective of the percent stenosis criterion used. However, it added significant incremental diagnostic information over clinical and exercise ECG data only concerning presence (e.g., ROC curve areas: presence of disease — clinical plus exercise ECG=83±2 vs clinical, exercise ECG, plus SPECT=87±2, p<0.001; extent of disease — clinical plus exercise ECG=83+4 vs clinical, exercise ECG, plus SPECT=85±3, p=0.11). Thallium LHR was an independent predictor of both presence and extent of disease (p<0.05), but the incremental information added to SPECT data did not reach statistical significance (e.g., ROC curve areas: presence of disease — SPECT=87±2 vs SPECT plus LHR=88±2, p=0.24; disease extent — SPECT=85±2 vs SPECT plus LHR=86±2, p=0.24). However, when combined, LHR and SPECT data had significant incremental value over clinical and exercise ECG data alone concerning extent of disease (e.g., ROC curve areas: clinical plus exercise ECG=83±4 vs clinical, exercise ECG, SPECT and LHr=86±3, p=0.04). Conclusion: SPECT thallium imaging variables are independent predictors of both presence and extent of coronary disease. However, they have significant incremental value over clinical and exercise ECG data concerning only presence of disease. Thallium LHR is an independent predictor of both presence and extent of disease but adds only a small insignificant amount of incremental diagnostic information over SPECT data. However, there was significant incremental value to the addition of LHR to SPECT data concerning extent of disease.
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DOI: 10.1016/S1071-3581(05)80061-3
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</title><author><name sortKey="Morise, P" sort="Morise, P" uniqKey="Morise P" first="P." last="Morise">P. Morise</name><affiliation><mods:affiliation>Section of Cardiology, Department of Medicine, West Virginia, University School of Medicine, 26506, Morgantown, W. Va</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:A477CE386D81E8112417D529DC32186F27251038</idno><date when="1995" year="1995">1995</date><idno type="doi">10.1016/S1071-3581(05)80061-3</idno><idno type="url">https://api.istex.fr/document/A477CE386D81E8112417D529DC32186F27251038/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">001675</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</title><author><name sortKey="Morise, P" sort="Morise, P" uniqKey="Morise P" first="P." last="Morise">P. Morise</name><affiliation><mods:affiliation>Section of Cardiology, Department of Medicine, West Virginia, University School of Medicine, 26506, Morgantown, W. Va</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Nuclear Cardiology</title><title level="j" type="abbrev">J Nucl Cardiol</title><idno type="ISSN">1071-3581</idno><idno type="eISSN">1532-6551</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>New York</pubPlace><date type="published" when="1995-05-01">1995-05-01</date><biblScope unit="volume">2</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="238">238</biblScope><biblScope unit="page" to="245">245</biblScope></imprint><idno type="ISSN">1071-3581</idno></series><idno type="istex">A477CE386D81E8112417D529DC32186F27251038</idno><idno type="DOI">10.1016/S1071-3581(05)80061-3</idno><idno type="ArticleID">Art7</idno><idno type="ArticleID">230238</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1071-3581</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Background: The goal was to assess the incremental diagnostic value of thallium single-photon emission computed tomographic (SPECT) imaging and lung/heart ratio (LHR) over other clinical and exercise electrocardiographic (ECG) variables concerning the presence and extent (three vessel/left main) of coronary artery disease. Methods and Results: Multivariable logistic regression analysis that used an incremental study design was applied to clinical, exercise test, SPECT, LHR, and catheterization data from 323 patients with suspected coronary disease. The following variables were evaluated as predictors of presence and extent of disease: clinical (age, sex, symptoms, diabetes, and smoking), exercise ECG (millimeters of ST segment depression, slope of ST segment depression, peak heart rate, change in systolic blood pressure, and metabolic equivalents of the task), and thallium (defect reversibility and intensity of hypoperfusion and LHR). Discrimination and incremental value were assessed by receiver operating characteristic (ROC) curve analysis. SPECT imaging (segment hypoperfusion score) was an independent predictor of both presence and extent of disease (p<0.0001) irrespective of the percent stenosis criterion used. However, it added significant incremental diagnostic information over clinical and exercise ECG data only concerning presence (e.g., ROC curve areas: presence of disease — clinical plus exercise ECG=83±2 vs clinical, exercise ECG, plus SPECT=87±2, p<0.001; extent of disease — clinical plus exercise ECG=83+4 vs clinical, exercise ECG, plus SPECT=85±3, p=0.11). Thallium LHR was an independent predictor of both presence and extent of disease (p<0.05), but the incremental information added to SPECT data did not reach statistical significance (e.g., ROC curve areas: presence of disease — SPECT=87±2 vs SPECT plus LHR=88±2, p=0.24; disease extent — SPECT=85±2 vs SPECT plus LHR=86±2, p=0.24). However, when combined, LHR and SPECT data had significant incremental value over clinical and exercise ECG data alone concerning extent of disease (e.g., ROC curve areas: clinical plus exercise ECG=83±4 vs clinical, exercise ECG, SPECT and LHr=86±3, p=0.04). Conclusion: SPECT thallium imaging variables are independent predictors of both presence and extent of coronary disease. However, they have significant incremental value over clinical and exercise ECG data concerning only presence of disease. Thallium LHR is an independent predictor of both presence and extent of disease but adds only a small insignificant amount of incremental diagnostic information over SPECT data. However, there was significant incremental value to the addition of LHR to SPECT data concerning extent of disease.</div></front></TEI><istex><corpusName>springer</corpusName><author><json:item><name>Anthony P. Morise</name><affiliations><json:string>Section of Cardiology, Department of Medicine, West Virginia, University School of Medicine, 26506, Morgantown, W. Va</json:string></affiliations></json:item></author><articleId><json:string>Art7</json:string><json:string>230238</json:string></articleId><language><json:string>eng</json:string></language><abstract>Abstract: Background: The goal was to assess the incremental diagnostic value of thallium single-photon emission computed tomographic (SPECT) imaging and lung/heart ratio (LHR) over other clinical and exercise electrocardiographic (ECG) variables concerning the presence and extent (three vessel/left main) of coronary artery disease. Methods and Results: Multivariable logistic regression analysis that used an incremental study design was applied to clinical, exercise test, SPECT, LHR, and catheterization data from 323 patients with suspected coronary disease. The following variables were evaluated as predictors of presence and extent of disease: clinical (age, sex, symptoms, diabetes, and smoking), exercise ECG (millimeters of ST segment depression, slope of ST segment depression, peak heart rate, change in systolic blood pressure, and metabolic equivalents of the task), and thallium (defect reversibility and intensity of hypoperfusion and LHR). Discrimination and incremental value were assessed by receiver operating characteristic (ROC) curve analysis. SPECT imaging (segment hypoperfusion score) was an independent predictor of both presence and extent of disease (p>0.0001) irrespective of the percent stenosis criterion used. However, it added significant incremental diagnostic information over clinical and exercise ECG data only concerning presence (e.g., ROC curve areas: presence of disease — clinical plus exercise ECG=83±2 vs clinical, exercise ECG, plus SPECT=87±2, p>0.001; extent of disease — clinical plus exercise ECG=83+4 vs clinical, exercise ECG, plus SPECT=85±3, p=0.11). Thallium LHR was an independent predictor of both presence and extent of disease (p>0.05), but the incremental information added to SPECT data did not reach statistical significance (e.g., ROC curve areas: presence of disease — SPECT=87±2 vs SPECT plus LHR=88±2, p=0.24; disease extent — SPECT=85±2 vs SPECT plus LHR=86±2, p=0.24). However, when combined, LHR and SPECT data had significant incremental value over clinical and exercise ECG data alone concerning extent of disease (e.g., ROC curve areas: clinical plus exercise ECG=83±4 vs clinical, exercise ECG, SPECT and LHr=86±3, p=0.04). Conclusion: SPECT thallium imaging variables are independent predictors of both presence and extent of coronary disease. However, they have significant incremental value over clinical and exercise ECG data concerning only presence of disease. Thallium LHR is an independent predictor of both presence and extent of disease but adds only a small insignificant amount of incremental diagnostic information over SPECT data. However, there was significant incremental value to the addition of LHR to SPECT data concerning extent of disease.</abstract><qualityIndicators><score>8</score><pdfVersion>1.3</pdfVersion><pdfPageSize>590.28 x 792 pts</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2735</abstractCharCount><pdfWordCount>5722</pdfWordCount><pdfCharCount>29494</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>383</abstractWordCount></qualityIndicators><title>An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</title><genre><json:string>research-article</json:string></genre><host><volume>2</volume><pages><last>245</last><first>238</first></pages><issn><json:string>1071-3581</json:string></issn><issue>3</issue><subject><json:item><value>Medicine & Public Health</value></json:item><json:item><value>Cardiology</value></json:item><json:item><value>Nuclear Medicine</value></json:item><json:item><value>Imaging / Radiology</value></json:item></subject><journalId><json:string>12350</json:string></journalId><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1532-6551</json:string></eissn><title>Journal of Nuclear Cardiology</title><publicationDate>1995</publicationDate><copyrightDate>1995</copyrightDate></host><publicationDate>1995</publicationDate><copyrightDate>1995</copyrightDate><doi><json:string>10.1016/S1071-3581(05)80061-3</json:string></doi><id>A477CE386D81E8112417D529DC32186F27251038</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/A477CE386D81E8112417D529DC32186F27251038/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/A477CE386D81E8112417D529DC32186F27251038/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/A477CE386D81E8112417D529DC32186F27251038/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</title><respStmt xml:id="ISTEX-API" resp="Références bibliographiques récupérées via GROBID" name="ISTEX-API (INIST-CNRS)"></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Springer-Verlag</publisher><pubPlace>New York</pubPlace><availability><p>SPRINGER</p></availability><date>1994-07-06</date></publicationStmt><notesStmt><note>Original Articles</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</title><author corresp="yes"><persName><forename type="first">Anthony</forename><surname>Morise</surname></persName><affiliation>Section of Cardiology, Department of Medicine, West Virginia, University School of Medicine, 26506, Morgantown, W. Va</affiliation></author></analytic><monogr><title level="j">Journal of Nuclear Cardiology</title><title level="j" type="abbrev">J Nucl Cardiol</title><idno type="JournalID">12350</idno><idno type="pISSN">1071-3581</idno><idno type="eISSN">1532-6551</idno><idno type="IssueArticleCount">15</idno><idno type="VolumeIssueCount">6</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>New York</pubPlace><date type="published" when="1995-05-01"></date><biblScope unit="volume">2</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="238">238</biblScope><biblScope unit="page" to="245">245</biblScope></imprint></monogr><idno type="istex">A477CE386D81E8112417D529DC32186F27251038</idno><idno type="DOI">10.1016/S1071-3581(05)80061-3</idno><idno type="ArticleID">Art7</idno><idno type="ArticleID">230238</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1994-07-06</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Abstract: Background: The goal was to assess the incremental diagnostic value of thallium single-photon emission computed tomographic (SPECT) imaging and lung/heart ratio (LHR) over other clinical and exercise electrocardiographic (ECG) variables concerning the presence and extent (three vessel/left main) of coronary artery disease. Methods and Results: Multivariable logistic regression analysis that used an incremental study design was applied to clinical, exercise test, SPECT, LHR, and catheterization data from 323 patients with suspected coronary disease. The following variables were evaluated as predictors of presence and extent of disease: clinical (age, sex, symptoms, diabetes, and smoking), exercise ECG (millimeters of ST segment depression, slope of ST segment depression, peak heart rate, change in systolic blood pressure, and metabolic equivalents of the task), and thallium (defect reversibility and intensity of hypoperfusion and LHR). Discrimination and incremental value were assessed by receiver operating characteristic (ROC) curve analysis. SPECT imaging (segment hypoperfusion score) was an independent predictor of both presence and extent of disease (p<0.0001) irrespective of the percent stenosis criterion used. However, it added significant incremental diagnostic information over clinical and exercise ECG data only concerning presence (e.g., ROC curve areas: presence of disease — clinical plus exercise ECG=83±2 vs clinical, exercise ECG, plus SPECT=87±2, p<0.001; extent of disease — clinical plus exercise ECG=83+4 vs clinical, exercise ECG, plus SPECT=85±3, p=0.11). Thallium LHR was an independent predictor of both presence and extent of disease (p<0.05), but the incremental information added to SPECT data did not reach statistical significance (e.g., ROC curve areas: presence of disease — SPECT=87±2 vs SPECT plus LHR=88±2, p=0.24; disease extent — SPECT=85±2 vs SPECT plus LHR=86±2, p=0.24). However, when combined, LHR and SPECT data had significant incremental value over clinical and exercise ECG data alone concerning extent of disease (e.g., ROC curve areas: clinical plus exercise ECG=83±4 vs clinical, exercise ECG, SPECT and LHr=86±3, p=0.04). Conclusion: SPECT thallium imaging variables are independent predictors of both presence and extent of coronary disease. However, they have significant incremental value over clinical and exercise ECG data concerning only presence of disease. Thallium LHR is an independent predictor of both presence and extent of disease but adds only a small insignificant amount of incremental diagnostic information over SPECT data. However, there was significant incremental value to the addition of LHR to SPECT data concerning extent of disease.</p></abstract><textClass><keywords scheme="Journal Subject Group"><list><label>H</label><label>H33037</label><label>H29048</label><label>H29005</label><item><term>Medicine & Public Health</term></item><item><term>Cardiology</term></item><item><term>Nuclear Medicine</term></item><item><term>Imaging / Radiology</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1994-07-06">Created</change><change when="1995-05-01">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-3-2">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/A477CE386D81E8112417D529DC32186F27251038/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Springer, Publisher found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//Springer-Verlag//DTD A++ V2.4//EN" URI="http://devel.springer.de/A++/V2.4/DTD/A++V2.4.dtd" name="istex:docType"></istex:docType><istex:document><Publisher><PublisherInfo><PublisherName>Springer-Verlag</PublisherName><PublisherLocation>New York</PublisherLocation></PublisherInfo><Journal><JournalInfo JournalProductType="ArchiveJournal" NumberingStyle="Unnumbered"><JournalID>12350</JournalID><JournalPrintISSN>1071-3581</JournalPrintISSN><JournalElectronicISSN>1532-6551</JournalElectronicISSN><JournalTitle>Journal of Nuclear Cardiology</JournalTitle><JournalAbbreviatedTitle>J Nucl Cardiol</JournalAbbreviatedTitle><JournalSubjectGroup><JournalSubject Code="H" Type="Primary">Medicine & Public Health</JournalSubject><JournalSubject Code="H33037" Priority="1" Type="Secondary">Cardiology</JournalSubject><JournalSubject Code="H29048" Priority="2" Type="Secondary">Nuclear Medicine</JournalSubject><JournalSubject Code="H29005" Priority="3" Type="Secondary">Imaging / Radiology</JournalSubject></JournalSubjectGroup></JournalInfo><Volume><VolumeInfo TocLevels="0" VolumeType="Regular"><VolumeIDStart>2</VolumeIDStart><VolumeIDEnd>2</VolumeIDEnd><VolumeIssueCount>6</VolumeIssueCount></VolumeInfo><Issue IssueType="Regular"><IssueInfo TocLevels="0"><IssueIDStart>3</IssueIDStart><IssueIDEnd>3</IssueIDEnd><IssueArticleCount>15</IssueArticleCount><IssueHistory><CoverDate><DateString>May/June 1995</DateString><Year>1995</Year><Month>5</Month></CoverDate></IssueHistory><IssueCopyright><CopyrightHolderName>American Society of Nuclear Cardiology</CopyrightHolderName><CopyrightYear>1995</CopyrightYear></IssueCopyright></IssueInfo><Article ID="Art7"><ArticleInfo ArticleType="OriginalPaper" ContainsESM="No" Language="En" NumberingStyle="Unnumbered" TocLevels="0"><ArticleID>230238</ArticleID><ArticleDOI>10.1016/S1071-3581(05)80061-3</ArticleDOI><ArticleSequenceNumber>7</ArticleSequenceNumber><ArticleTitle Language="En">An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</ArticleTitle><ArticleCategory>Original Articles</ArticleCategory><ArticleFirstPage>238</ArticleFirstPage><ArticleLastPage>245</ArticleLastPage><ArticleHistory><RegistrationDate><Year>2005</Year><Month>11</Month><Day>4</Day></RegistrationDate><Received><Year>1994</Year><Month>7</Month><Day>6</Day></Received><Accepted><Year>1995</Year><Month>1</Month><Day>23</Day></Accepted></ArticleHistory><ArticleCopyright><CopyrightHolderName>American Society of Nuclear Cardiology</CopyrightHolderName><CopyrightYear>1995</CopyrightYear></ArticleCopyright><ArticleGrants Type="Regular"><MetadataGrant Grant="OpenAccess"></MetadataGrant><AbstractGrant Grant="OpenAccess"></AbstractGrant><BodyPDFGrant Grant="Restricted"></BodyPDFGrant><BodyHTMLGrant Grant="Restricted"></BodyHTMLGrant><BibliographyGrant Grant="Restricted"></BibliographyGrant><ESMGrant Grant="Restricted"></ESMGrant></ArticleGrants><ArticleContext><JournalID>12350</JournalID><VolumeIDStart>2</VolumeIDStart><VolumeIDEnd>2</VolumeIDEnd><IssueIDStart>3</IssueIDStart><IssueIDEnd>3</IssueIDEnd></ArticleContext></ArticleInfo><ArticleHeader><AuthorGroup><Author AffiliationIDS="Aff1" CorrespondingAffiliationID="Aff1"><AuthorName DisplayOrder="Western"><GivenName>Anthony</GivenName><GivenName>P.</GivenName><FamilyName>Morise</FamilyName></AuthorName></Author><Affiliation ID="Aff1"><OrgDivision>Section of Cardiology, Department of Medicine, West Virginia</OrgDivision><OrgName>University School of Medicine</OrgName><OrgAddress><Postcode>26506</Postcode><City>Morgantown</City><State>W. Va</State></OrgAddress></Affiliation></AuthorGroup><Abstract ID="Abs1" Language="En"><Heading>Abstract</Heading><AbstractSection ID="Asec1"><Heading>Background</Heading><Para>The goal was to assess the incremental diagnostic value of thallium single-photon emission computed tomographic (SPECT) imaging and lung/heart ratio (LHR) over other clinical and exercise electrocardiographic (ECG) variables concerning the presence and extent (three vessel/left main) of coronary artery disease.</Para></AbstractSection><AbstractSection ID="Asec2"><Heading>Methods and Results</Heading><Para>Multivariable logistic regression analysis that used an incremental study design was applied to clinical, exercise test, SPECT, LHR, and catheterization data from 323 patients with suspected coronary disease. The following variables were evaluated as predictors of presence and extent of disease: clinical (age, sex, symptoms, diabetes, and smoking), exercise ECG (millimeters of ST segment depression, slope of ST segment depression, peak heart rate, change in systolic blood pressure, and metabolic equivalents of the task), and thallium (defect reversibility and intensity of hypoperfusion and LHR). Discrimination and incremental value were assessed by receiver operating characteristic (ROC) curve analysis. SPECT imaging (segment hypoperfusion score) was an independent predictor of both presence and extent of disease (<Emphasis Type="Italic">p</Emphasis><0.0001) irrespective of the percent stenosis criterion used. However, it added significant incremental diagnostic information over clinical and exercise ECG data only concerning presence (e.g., ROC curve areas: presence of disease — clinical plus exercise ECG=83±2 vs clinical, exercise ECG, plus SPECT=87±2, <Emphasis Type="Italic">p</Emphasis><0.001; extent of disease — clinical plus exercise ECG=83+4 vs clinical, exercise ECG, plus SPECT=85±3, <Emphasis Type="Italic">p</Emphasis>=0.11). Thallium LHR was an independent predictor of both presence and extent of disease (<Emphasis Type="Italic">p</Emphasis><0.05), but the incremental information added to SPECT data did not reach statistical significance (e.g., ROC curve areas: presence of disease — SPECT=87±2 vs SPECT plus LHR=88±2, <Emphasis Type="Italic">p</Emphasis>=0.24; disease extent — SPECT=85±2 vs SPECT plus LHR=86±2, <Emphasis Type="Italic">p</Emphasis>=0.24). However, when combined, LHR and SPECT data had significant incremental value over clinical and exercise ECG data alone concerning extent of disease (e.g., ROC curve areas: clinical plus exercise ECG=83±4 vs clinical, exercise ECG, SPECT and LHr=86±3, <Emphasis Type="Italic">p</Emphasis>=0.04).</Para></AbstractSection><AbstractSection ID="Asec3"><Heading>Conclusion</Heading><Para>SPECT thallium imaging variables are independent predictors of both presence and extent of coronary disease. However, they have significant incremental value over clinical and exercise ECG data concerning only presence of disease. Thallium LHR is an independent predictor of both presence and extent of disease but adds only a small insignificant amount of incremental diagnostic information over SPECT data. However, there was significant incremental value to the addition of LHR to SPECT data concerning extent of disease.</Para></AbstractSection></Abstract><KeywordGroup Language="En"><Heading>Key Words</Heading><Keyword>thallium</Keyword><Keyword>coronary disease</Keyword><Keyword>diagnosis</Keyword><Keyword>angiography</Keyword></KeywordGroup></ArticleHeader><NoBody></NoBody></Article></Issue></Volume></Journal></Publisher></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>An incremental evaluation of the diagnostic value of thallium single-photon emission computed tomographic imaging and lung/heart ratio concerning both the presence and extent of coronary artery disease</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Anthony</namePart><namePart type="given">P.</namePart><namePart type="family">Morise</namePart><affiliation>Section of Cardiology, Department of Medicine, West Virginia, University School of Medicine, 26506, Morgantown, W. Va</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="OriginalPaper"></genre><originInfo><publisher>Springer-Verlag</publisher><place><placeTerm type="text">New York</placeTerm></place><dateCreated encoding="w3cdtf">1994-07-06</dateCreated><dateIssued encoding="w3cdtf">1995-05-01</dateIssued><copyrightDate encoding="w3cdtf">1995</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Abstract: Background: The goal was to assess the incremental diagnostic value of thallium single-photon emission computed tomographic (SPECT) imaging and lung/heart ratio (LHR) over other clinical and exercise electrocardiographic (ECG) variables concerning the presence and extent (three vessel/left main) of coronary artery disease. Methods and Results: Multivariable logistic regression analysis that used an incremental study design was applied to clinical, exercise test, SPECT, LHR, and catheterization data from 323 patients with suspected coronary disease. The following variables were evaluated as predictors of presence and extent of disease: clinical (age, sex, symptoms, diabetes, and smoking), exercise ECG (millimeters of ST segment depression, slope of ST segment depression, peak heart rate, change in systolic blood pressure, and metabolic equivalents of the task), and thallium (defect reversibility and intensity of hypoperfusion and LHR). Discrimination and incremental value were assessed by receiver operating characteristic (ROC) curve analysis. SPECT imaging (segment hypoperfusion score) was an independent predictor of both presence and extent of disease (p<0.0001) irrespective of the percent stenosis criterion used. However, it added significant incremental diagnostic information over clinical and exercise ECG data only concerning presence (e.g., ROC curve areas: presence of disease — clinical plus exercise ECG=83±2 vs clinical, exercise ECG, plus SPECT=87±2, p<0.001; extent of disease — clinical plus exercise ECG=83+4 vs clinical, exercise ECG, plus SPECT=85±3, p=0.11). Thallium LHR was an independent predictor of both presence and extent of disease (p<0.05), but the incremental information added to SPECT data did not reach statistical significance (e.g., ROC curve areas: presence of disease — SPECT=87±2 vs SPECT plus LHR=88±2, p=0.24; disease extent — SPECT=85±2 vs SPECT plus LHR=86±2, p=0.24). However, when combined, LHR and SPECT data had significant incremental value over clinical and exercise ECG data alone concerning extent of disease (e.g., ROC curve areas: clinical plus exercise ECG=83±4 vs clinical, exercise ECG, SPECT and LHr=86±3, p=0.04). Conclusion: SPECT thallium imaging variables are independent predictors of both presence and extent of coronary disease. However, they have significant incremental value over clinical and exercise ECG data concerning only presence of disease. Thallium LHR is an independent predictor of both presence and extent of disease but adds only a small insignificant amount of incremental diagnostic information over SPECT data. However, there was significant incremental value to the addition of LHR to SPECT data concerning extent of disease.</abstract><note>Original Articles</note><relatedItem type="host"><titleInfo><title>Journal of Nuclear Cardiology</title></titleInfo><titleInfo type="abbreviated"><title>J Nucl Cardiol</title></titleInfo><genre type="Journal" displayLabel="Archive Journal"></genre><originInfo><dateIssued encoding="w3cdtf">1995-05-01</dateIssued><copyrightDate encoding="w3cdtf">1995</copyrightDate></originInfo><subject><genre>Journal Subject Group</genre><topic authority="SpringerSubjectCodes" authorityURI="H">Medicine & Public Health</topic><topic authority="SpringerSubjectCodes" authorityURI="H33037">Cardiology</topic><topic authority="SpringerSubjectCodes" authorityURI="H29048">Nuclear Medicine</topic><topic authority="SpringerSubjectCodes" authorityURI="H29005">Imaging / Radiology</topic></subject><identifier type="ISSN">1071-3581</identifier><identifier type="eISSN">1532-6551</identifier><identifier type="JournalID">12350</identifier><identifier type="IssueArticleCount">15</identifier><identifier type="VolumeIssueCount">6</identifier><part><date>1995</date><detail type="volume"><number>2</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="pages"><start>238</start><end>245</end></extent></part><recordInfo><recordOrigin>American Society of Nuclear Cardiology, 1995</recordOrigin></recordInfo></relatedItem><identifier type="istex">A477CE386D81E8112417D529DC32186F27251038</identifier><identifier type="DOI">10.1016/S1071-3581(05)80061-3</identifier><identifier type="ArticleID">Art7</identifier><identifier type="ArticleID">230238</identifier><accessCondition type="use and reproduction" contentType="copyright">American Society of Nuclear Cardiology</accessCondition><recordInfo><recordContentSource>SPRINGER</recordContentSource><recordOrigin>American Society of Nuclear 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