News | December 31, 2013

Study Reveals Sensitivity of Common Exercise Tests for Suspected CAD May be Overestimated

December 31, 2013 — A study published in the Journal of the American Heart Association revealed findings that may impact diagnostic strategies and clinical decision-making for patients with suspected coronary artery disease (CAD).
 
The study, “Clinical Implications of Referral Bias in the Diagnostic Performance of Exercise Testing for Coronary Artery Disease,” examined the issue of referral bias in assessments of diagnostic performance for exercise testing with echocardiography (echo) or myocardial perfusion imaging (MPI).
 
Referral bias occurs when patients with an abnormal stress test result are referred to cardiac catheterization at a higher rate than patients with normal stress test results. While clinically appropriate, failing to adjust for this difference in referral rates when measuring test performance can significantly distort the observed diagnostic characteristics of exercise testing.
 
The study authors conducted a meta-analysis of 21 studies examining CAD referral patterns in 49,006 patients. After systematically reviewing cardiac catheterization referral rates and aggregating them to adjust pooled estimates of exercise test performance, the authors found that adjusting for referral bias significantly reduced test sensitivity and increased test specificity.
 
“We found that the sensitivity of exercise testing is much lower than previously reported. Wider recognition of this among clinicians — particularly primary care physicians and hospitalists — may influence how healthcare professionals use exercise echo and MPI to rule-in versus rule-out disease,” said Joseph Ladapo, M.D., Ph.D., assistant professor, departments of population health and medicine, NYU Langone Medical Center, and lead author.
 
The study found exercise echocardiography and myocardial perfusion imaging are considerably less sensitive and more specific for CAD after adjustment for referral. Given these findings, researchers said future work should assess the comparative ability of these and other tests to rule?in versus rule?out coronary artery disease.
 
A K23 Career Development Award from the National Heart, Lung, and Blood Institute (NHLBI) supported Ladapo’s work. CardioDx also helped fund the study.
 
For more information: jaha.ahajournals.org

Related Content

Hershey's Chocolate display with samples and coco pods at the American College of Cardiology (ACC) 2012 annual meeting. The company was making the case that chocolate can be good for your heart, which is now supported by several studies. Photo by Dave Fornell

Hershey's Chocolate display with samples and coco pods at the American College of Cardiology (ACC) 2012 annual meeting. The company was making the case that chocolate can be good for your heart, which is now supported by several studies. Photo by Dave Fornell

News | Cardiovascular Clinical Studies | July 22, 2020
July 22, 2020 — Eating chocolate at least once a week is linked with a reduced risk of heart disease, according to re
The first 3-D images have been created of an RNA molecule known as "Braveheart" for its role in transforming stem cells into heart cells. Credit: Image courtesy Los Alamos National Laboratory

The first 3-D images have been created of an RNA molecule known as "Braveheart" for its role in transforming stem cells into heart cells. Credit: Image courtesy Los Alamos National Laboratory

News | Cardiovascular Clinical Studies | January 20, 2020
January 20, 2020 — Scientists at Los Alamos and international partners have created the first 3-D images of a special
Top Cardiology New in 2019 From the European Society of Cardioloigy (ESC)
News | Cardiovascular Clinical Studies | December 23, 2019
Environmental and lifestyle issues were popular this year, with pick up from both...
News | Cardiovascular Clinical Studies | November 26, 2019
November 26, 2019 — The University of Connecticut (UConn) Department of Kinesiology and Hartford Healthcare have sele
FDA Issues Final Guidance on Live Case Presentations During IDE Clinical Trials
News | Cardiovascular Clinical Studies | July 10, 2019
The U.S. Food and Drug Administration (FDA) issued the final guidance “Live Case Presentations During Investigational...
Veradigm Partners With American College of Cardiology on Next-generation Research Registries
News | Cardiovascular Clinical Studies | July 03, 2019
The American College of Cardiology (ACC) has partnered with Veradigm, an Allscripts business unit, to power the next...
New FDA Proposed Rule Alters Informed Consent for Clinical Studies
News | Cardiovascular Clinical Studies | November 19, 2018
The U.S. Food and Drug Administration (FDA) is proposing to add an exception to informed consent requirements for...
A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development. #SCAI, #SCAI2018

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development.  

Feature | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 – New clinical evidance shows common therapy options for psoriasis (PSO), a chronic inflammatory skin di
Intravenous Drug Use is Causing Rise in Heart Valve Infections, Healthcare Costs. #SCAI, #SCAI2018
News | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 — The opioid drug epidemic is impacting cardiology, with a new study finding the number of patients hosp