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Cardiovascular Imaging A handbook for clinical practice - Part 6

Kết quả cho thấy rằng, với ngoại lệ của DSE, mỗi bài kiểm tra đã chứng minh một sự thiên vị cho một giá trị tiên đoán tốt hơn trong các nghiên cứu trước đó. Mặc dù DSE xuất hiện được tốt nhất trong số các xét nghiệm và điện tâm đồ cấp cứu có giá trị tiên đoán ít nhất | Risk stratification before non-cardiac surgery 141 Figure 12.2 Continued. c Quad-screen of a normal echocardiography at rest. Panels are apical four-chamber view left upper apical two-chamber view right upper apical three-chamber view left lower and short axis view right lower . See also Video clip 10 y . d Dobutamine stress-induced myocardial ischemia. The images show left ventricular hypertrophy and myocardial ischemia developed at peak stress lower left panel in the posterior septum indicated by arrows . See also Video clip 11 . 142 Chapter 12 results showed that with the exception of DSE each of the tests demonstrated a bias for a better predictive value in the earlier studies. Although DSE appeared to be the best among these tests and ambulatory electrocardiography to have the least predictive value the available data analyzed were not sufficient to determine which test is optimal. Results of a similar meta-analysis by Shaw et al.23 comparing the predictive value of dipyridamole 201Tl scintigraphy and DSE for risk stratification before vascular surgery showed that the prognostic value of both non-invasive stress tests had similar predictive accuracy but the summed odds ratios for cardiac death and myocardial infarction were greater for DSE than for dipyridamole perfusion scintigraphy. Recently Kertai et al.24 compared the predictive value of dobutamine and dipyridamole stress echocardiography and dipyridamole 201Tl scintigraphy in 2204 patients undergoing major vascular surgery. Of these 2204 consecutive patients 1093 underwent DSE 394 patients had dipyridamole stress echocardiography and 717 patients had dipyridamole 201Tl scintigraphy before major vascular surgery. There was no statistically significant difference in the predictive value of a positive test result for dipyridamole stress echocardiography and DSE but a positive test result for dipyridamole 201Tl scintigraphy had a significantly lower prognostic value. Finally using a novel meta-analytic .