Comparison of Electron Beam Computed Tomography and Exercise Electrocardiography in Detecting Coronary Artery Disease in the Elderly
Although exercise electrocardiography (ECG) is a useful noninvasive screening test for coronary artery disease (CAD), one prerequisite for ECG screening is that patient be able to exercise enough to evoke myocardial ischemia. Thus, exercise ECG may not be suitable for, some elderly people with CAD w...
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| Published in | Nihon Rōnen Igakkai zasshi Vol. 35; no. 8; pp. 626 - 630 |
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| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan
The Japan Geriatrics Society
1998
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.35.626 |
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| Abstract | Although exercise electrocardiography (ECG) is a useful noninvasive screening test for coronary artery disease (CAD), one prerequisite for ECG screening is that patient be able to exercise enough to evoke myocardial ischemia. Thus, exercise ECG may not be suitable for, some elderly people with CAD who cannot exercise enough. We compared electron beam Computed Tomography (EBCT) with exercise ECG for detecting CAD in 196 patients (mean age, 58.4±12.5 [standard deviation]) who had undergone coronary angiography. Using the angiographic findings as the “gold standard”, we found that the sensitivity, specificity, positive predictive value, and negative predictive value were 88%, 77%, 89%, and 77%, respectively, for EBCT, and 66%, 72%, 83%, and 52%, respectively, for exercise ECG. Although the results were similar when the subjects were divided into different age groups, the negative predictive value for exercise ECG, among older patients was very low. These findings suggest that EBCT is superior to exercise ECG in detecting CAD in the elderly. |
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| AbstractList | Although exercise electrocardiography (ECG) is a useful noninvasive screening test for coronary artery disease (CAD), one prerequisite for ECG screening is that patient be able to exercise enough to evoke myocardial ischemia. Thus, exercise ECG may not be suitable for, some elderly people with CAD who cannot exercise enough. We compared electron beam Computed Tomography (EBCT) with exercise ECG for detecting CAD in 196 patients (mean age, 58.4 +/- 12.5 [standard deviation]) who had undergone coronary angiography. Using the angiographic findings as the "gold standard", we found that the sensitivity, specificity, positive predictive value, and negative predictive value were 88%, 77%, 89%, and 77%, respectively, for EBCT, and 66%, 72%, 83%, and 52%, respectively, for exercise ECG. Although the results were similar when the subjects were divided into different age groups, the negative predictive value for exercise ECG, among older patients was very low. These findings suggest that EBCT is superior to exercise ECG in detecting CAD in the elderly. Although exercise electrocardiography (ECG) is a useful noninvasive screening test for coronary artery disease (CAD), one prerequisite for ECG screening is that patient be able to exercise enough to evoke myocardial ischemia. Thus, exercise ECG may not be suitable for, some elderly people with CAD who cannot exercise enough. We compared electron beam Computed Tomography (EBCT) with exercise ECG for detecting CAD in 196 patients (mean age, 58.4 +/- 12.5 [standard deviation]) who had undergone coronary angiography. Using the angiographic findings as the "gold standard", we found that the sensitivity, specificity, positive predictive value, and negative predictive value were 88%, 77%, 89%, and 77%, respectively, for EBCT, and 66%, 72%, 83%, and 52%, respectively, for exercise ECG. Although the results were similar when the subjects were divided into different age groups, the negative predictive value for exercise ECG, among older patients was very low. These findings suggest that EBCT is superior to exercise ECG in detecting CAD in the elderly.Although exercise electrocardiography (ECG) is a useful noninvasive screening test for coronary artery disease (CAD), one prerequisite for ECG screening is that patient be able to exercise enough to evoke myocardial ischemia. Thus, exercise ECG may not be suitable for, some elderly people with CAD who cannot exercise enough. We compared electron beam Computed Tomography (EBCT) with exercise ECG for detecting CAD in 196 patients (mean age, 58.4 +/- 12.5 [standard deviation]) who had undergone coronary angiography. Using the angiographic findings as the "gold standard", we found that the sensitivity, specificity, positive predictive value, and negative predictive value were 88%, 77%, 89%, and 77%, respectively, for EBCT, and 66%, 72%, 83%, and 52%, respectively, for exercise ECG. Although the results were similar when the subjects were divided into different age groups, the negative predictive value for exercise ECG, among older patients was very low. These findings suggest that EBCT is superior to exercise ECG in detecting CAD in the elderly. Although exercise electrocardiography (ECG) is a useful noninvasive screening test for coronary artery disease (CAD), one prerequisite for ECG screening is that patient be able to exercise enough to evoke myocardial ischemia. Thus, exercise ECG may not be suitable for, some elderly people with CAD who cannot exercise enough. We compared electron beam Computed Tomography (EBCT) with exercise ECG for detecting CAD in 196 patients (mean age, 58.4±12.5 [standard deviation]) who had undergone coronary angiography. Using the angiographic findings as the “gold standard”, we found that the sensitivity, specificity, positive predictive value, and negative predictive value were 88%, 77%, 89%, and 77%, respectively, for EBCT, and 66%, 72%, 83%, and 52%, respectively, for exercise ECG. Although the results were similar when the subjects were divided into different age groups, the negative predictive value for exercise ECG, among older patients was very low. These findings suggest that EBCT is superior to exercise ECG in detecting CAD in the elderly. |
| Author | Kinoshita, Masahiko Mitsunami, Kenichi Inoue, Shinji |
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| References | 6) John AR Patric FS, Jerome FB, Robert SS: Electron beam computed tomography coronary calciumu score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 1997; 29: 1542-48. 1) Tanenbaum SR, Kondos GT, Veselic KE, Predergast MR, Brundage BH, Chomka EV: Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. Am J Cardiol 1989; 63: 870-871. 5) Kajinami K, Seki H, Takekosi N, Mabuchi H: Coronary calcification and coronary atherosclerosis: site by site comparative morphologic study of electron beam computed tomography and coronary angiography. J Am Coll Cardiol 1997; 29: 1549-56. 8) Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Drtrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827-832. 3) Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al.: Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease. Circulation 1996; 93: 898-904. 4) Manning WJ, Li W, Edelman RR: A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med 1993; 328: 828-832. 11) Frink RJ, Archor RWP, Brown AL, Kincaid OW, Brandenburg RO: Signifisance of calcification of the coronary arteries. Am J Cardiol 1970; 26: 241-247. 12) McCarthy JH, Palmar FJ: Incidence and significance of coronary artery calcification. Br Heart J 1974; 36: 499-506. 10) Bernard RC: Exercise stress testing, Heart disease, Eugene Braunwald (ed), fifth edition, W. B. Saunders company. Philadelphia 1997; 153-176. 15) Kajinami K, Seki H, Takekosi N, Mabuchi H: Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium xercise stress test results. J Am Coll Cardiol 1995; 26: 1209-21. 17) Moshage WEL, Achenbach S, Seese B, Bachmann K, Kirchgeorg M: Coronary artery stenoses: three dimensional imaging with electrocardiographically triggered, contrast agent-enhanced, electron beam CT. Radiology 1995; 196: 707-714. 9) Fletcher GF, Balady G, Froelicher VF, et al.: Exercise standards. A statement for healthcare professionals from the American Heart Association. Circulation 1995; 91: 580. 13) Bartel AG, Chen JT, Peter RH, Behar VS, Hong Y, Lester RG: The significance of coronary calcification detected by fluoroscopy. Circulation 1974; 49: 1247-1253. 2) Breen JF, Sheedy PF, Schwartz RS, et al.: Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease. Radiology 1992; 185: 435-439. 16) Barrtt-Connor E, Bush TL: Estrogen and coronary heart disease in women. JAMA 1991; 265: 1861-1867. 14) 浜田星紀, 高宮誠, 斎藤春夫: 超高速CTによる冠動脈石灰化の評価. 日本医放会誌1991; 51: 1299-1305. 7) Dietrich B, Axel S, Guenter G, et al.: Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997; 30: 57-64. |
| References_xml | – reference: 12) McCarthy JH, Palmar FJ: Incidence and significance of coronary artery calcification. Br Heart J 1974; 36: 499-506. – reference: 4) Manning WJ, Li W, Edelman RR: A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med 1993; 328: 828-832. – reference: 3) Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al.: Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease. Circulation 1996; 93: 898-904. – reference: 16) Barrtt-Connor E, Bush TL: Estrogen and coronary heart disease in women. JAMA 1991; 265: 1861-1867. – reference: 5) Kajinami K, Seki H, Takekosi N, Mabuchi H: Coronary calcification and coronary atherosclerosis: site by site comparative morphologic study of electron beam computed tomography and coronary angiography. J Am Coll Cardiol 1997; 29: 1549-56. – reference: 8) Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Drtrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827-832. – reference: 9) Fletcher GF, Balady G, Froelicher VF, et al.: Exercise standards. A statement for healthcare professionals from the American Heart Association. Circulation 1995; 91: 580. – reference: 14) 浜田星紀, 高宮誠, 斎藤春夫: 超高速CTによる冠動脈石灰化の評価. 日本医放会誌1991; 51: 1299-1305. – reference: 1) Tanenbaum SR, Kondos GT, Veselic KE, Predergast MR, Brundage BH, Chomka EV: Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. Am J Cardiol 1989; 63: 870-871. – reference: 7) Dietrich B, Axel S, Guenter G, et al.: Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997; 30: 57-64. – reference: 15) Kajinami K, Seki H, Takekosi N, Mabuchi H: Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium xercise stress test results. J Am Coll Cardiol 1995; 26: 1209-21. – reference: 17) Moshage WEL, Achenbach S, Seese B, Bachmann K, Kirchgeorg M: Coronary artery stenoses: three dimensional imaging with electrocardiographically triggered, contrast agent-enhanced, electron beam CT. Radiology 1995; 196: 707-714. – reference: 6) John AR Patric FS, Jerome FB, Robert SS: Electron beam computed tomography coronary calciumu score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 1997; 29: 1542-48. – reference: 13) Bartel AG, Chen JT, Peter RH, Behar VS, Hong Y, Lester RG: The significance of coronary calcification detected by fluoroscopy. Circulation 1974; 49: 1247-1253. – reference: 10) Bernard RC: Exercise stress testing, Heart disease, Eugene Braunwald (ed), fifth edition, W. B. Saunders company. Philadelphia 1997; 153-176. – reference: 11) Frink RJ, Archor RWP, Brown AL, Kincaid OW, Brandenburg RO: Signifisance of calcification of the coronary arteries. Am J Cardiol 1970; 26: 241-247. – reference: 2) Breen JF, Sheedy PF, Schwartz RS, et al.: Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease. Radiology 1992; 185: 435-439. |
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| SubjectTerms | Aged aging Aging - physiology coronary artery disease Coronary Disease - diagnosis Electrocardiography electron beam CT exercise ECG Exercise Test Female Humans Male Middle Aged Predictive Value of Tests Sensitivity and Specificity Tomography, X-Ray Computed |
| Title | Comparison of Electron Beam Computed Tomography and Exercise Electrocardiography in Detecting Coronary Artery Disease in the Elderly |
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