The diagnostic accuracy of myocardial perfusion scintigraphy in athletes with abnormal exercise test results
Background Previous studies revealed a relatively high prevalence of electrocardiographic findings indicative for myocardial ischemia in asymptomatic athletes undergoing pre-participation screening. Myocardial perfusion scintigraphy is generally considered a valuable diagnostic and prognostic modali...
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| Veröffentlicht in: | European journal of preventive cardiology 2017-06, Vol.24 (9), p.1000-1007 |
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| creator | van de Sande, Danny AJP Liem, Ing Han Hoogsteen, Jan Kemps, Hareld MC |
| description | Background
Previous studies revealed a relatively high prevalence of electrocardiographic findings indicative for myocardial ischemia in asymptomatic athletes undergoing pre-participation screening. Myocardial perfusion scintigraphy is generally considered a valuable diagnostic and prognostic modality and often used for further diagnostic evaluation in these subjects. However, data on the diagnostic accuracy of myocardial perfusion scintigraphy in athletes are scarce.
Objectives
The main purpose of this study was to investigate the positive predictive value of myocardial perfusion scintigraphy for detection of coronary artery disease in asymptomatic athletes with abnormal exercise testing results during pre-participation screening. The secondary aim was to evaluate the prognostic value of myocardial perfusion scintigraphy.
Methods
Electronic charts of asymptomatic athletes who underwent myocardial perfusion scintigraphy following an abnormal exercise testing were retrospectively reviewed. Myocardial perfusion scintigraphy and exercise testing studies were revised. Athlete characteristics and cardiovascular risk factors were evaluated.
Results
One hundred and forty-three athletes were included. 29 athletes (20%) showed concordant abnormal exercise testing and myocardial perfusion scintigraphy results. Coronary imaging was performed in 20 of these 29 athletes. Four athletes showed significant coronary artery disease (positive predictive value = 20%). The positive predictive value increased to 33% when athletes were selected who should have undergone exercise testing according to the guideline recommendations. During a mean follow-up interval of 4.7 ± 2.2 years, eight cardiac events occurred. Athletes with an abnormal myocardial perfusion scintigraphy result had a fourfold increased risk at a future cardiac event (2.9%/year versus 0.75%/year, p = 0.031).
Conclusions
The positive predictive value of myocardial perfusion scintigraphy for the detection of significant coronary artery disease in asymptomatic athletes with a positive exercise testing result is low, even in a selection of athletes with a relatively high cardiovascular risk. Although an abnormal myocardial perfusion scintigraphy result was associated with a fourfold higher annual event rate, the absolute annual event rate in this group was still low. Efforts should be made to develop better diagnostic strategies to evaluate asymptomatic athletes with abnormal exercise testing results during pre-parti |
| doi_str_mv | 10.1177/2047487317693135 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1867547333</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_2047487317693135</sage_id><sourcerecordid>1867547333</sourcerecordid><originalsourceid>FETCH-LOGICAL-c337t-d4c3ab61616f2d988765db01062879d3b3a84d856ef6fdd7a025b5541eb377773</originalsourceid><addsrcrecordid>eNp1UD1PwzAUtBCIotKdCXlkCdixY7sjqviSKrGUOXJsp3GVxMF2BPn3uGrpgMS94T353Z38DoAbjO4x5vwhR5RTwQnmbEkwKc7A1f4po0Lg89PMyQwsQtihBIbyXIhLMMsFFoxSegXaTWOgtnLbuxCtglKp0Us1QVfDbnJK-rRs4WB8PQbrehiU7aPdejk0E7Q9lLFpTTQBftnYQFn1zndJYL6NVzYYmFYRehPGNoZrcFHLNpjFsc_Bx_PTZvWard9f3laP60wRwmOmqSKyYjhVneulEJwVukIYsVzwpSYVkYJqUTBTs1prLlFeVEVBsakITyBzcHfwHbz7HNMHys4GZdpW9saNoUzH84JykjAH6EBV3oXgTV0O3nbSTyVG5T7m8m_MSXJ7dB-rzuiT4DfURMgOhCC3pty50ffp2v8NfwD7vIXc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1867547333</pqid></control><display><type>article</type><title>The diagnostic accuracy of myocardial perfusion scintigraphy in athletes with abnormal exercise test results</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>SAGE Complete</source><source>Alma/SFX Local Collection</source><creator>van de Sande, Danny AJP ; Liem, Ing Han ; Hoogsteen, Jan ; Kemps, Hareld MC</creator><creatorcontrib>van de Sande, Danny AJP ; Liem, Ing Han ; Hoogsteen, Jan ; Kemps, Hareld MC</creatorcontrib><description>Background
Previous studies revealed a relatively high prevalence of electrocardiographic findings indicative for myocardial ischemia in asymptomatic athletes undergoing pre-participation screening. Myocardial perfusion scintigraphy is generally considered a valuable diagnostic and prognostic modality and often used for further diagnostic evaluation in these subjects. However, data on the diagnostic accuracy of myocardial perfusion scintigraphy in athletes are scarce.
Objectives
The main purpose of this study was to investigate the positive predictive value of myocardial perfusion scintigraphy for detection of coronary artery disease in asymptomatic athletes with abnormal exercise testing results during pre-participation screening. The secondary aim was to evaluate the prognostic value of myocardial perfusion scintigraphy.
Methods
Electronic charts of asymptomatic athletes who underwent myocardial perfusion scintigraphy following an abnormal exercise testing were retrospectively reviewed. Myocardial perfusion scintigraphy and exercise testing studies were revised. Athlete characteristics and cardiovascular risk factors were evaluated.
Results
One hundred and forty-three athletes were included. 29 athletes (20%) showed concordant abnormal exercise testing and myocardial perfusion scintigraphy results. Coronary imaging was performed in 20 of these 29 athletes. Four athletes showed significant coronary artery disease (positive predictive value = 20%). The positive predictive value increased to 33% when athletes were selected who should have undergone exercise testing according to the guideline recommendations. During a mean follow-up interval of 4.7 ± 2.2 years, eight cardiac events occurred. Athletes with an abnormal myocardial perfusion scintigraphy result had a fourfold increased risk at a future cardiac event (2.9%/year versus 0.75%/year, p = 0.031).
Conclusions
The positive predictive value of myocardial perfusion scintigraphy for the detection of significant coronary artery disease in asymptomatic athletes with a positive exercise testing result is low, even in a selection of athletes with a relatively high cardiovascular risk. Although an abnormal myocardial perfusion scintigraphy result was associated with a fourfold higher annual event rate, the absolute annual event rate in this group was still low. Efforts should be made to develop better diagnostic strategies to evaluate asymptomatic athletes with abnormal exercise testing results during pre-participation screening.</description><identifier>ISSN: 2047-4873</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1177/2047487317693135</identifier><identifier>PMID: 28186444</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Athletes ; Computed Tomography Angiography ; Coronary Angiography - methods ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - mortality ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - therapy ; Coronary Circulation ; Exercise Test ; Female ; Humans ; Male ; Middle Aged ; Myocardial Ischemia - diagnostic imaging ; Myocardial Ischemia - mortality ; Myocardial Ischemia - physiopathology ; Myocardial Ischemia - therapy ; Myocardial Perfusion Imaging - methods ; Organophosphorus Compounds - administration & dosage ; Organotechnetium Compounds - administration & dosage ; Predictive Value of Tests ; Prognosis ; Radiopharmaceuticals - administration & dosage ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors</subject><ispartof>European journal of preventive cardiology, 2017-06, Vol.24 (9), p.1000-1007</ispartof><rights>The European Society of Cardiology 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-d4c3ab61616f2d988765db01062879d3b3a84d856ef6fdd7a025b5541eb377773</citedby><cites>FETCH-LOGICAL-c337t-d4c3ab61616f2d988765db01062879d3b3a84d856ef6fdd7a025b5541eb377773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2047487317693135$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2047487317693135$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28186444$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van de Sande, Danny AJP</creatorcontrib><creatorcontrib>Liem, Ing Han</creatorcontrib><creatorcontrib>Hoogsteen, Jan</creatorcontrib><creatorcontrib>Kemps, Hareld MC</creatorcontrib><title>The diagnostic accuracy of myocardial perfusion scintigraphy in athletes with abnormal exercise test results</title><title>European journal of preventive cardiology</title><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><description>Background
Previous studies revealed a relatively high prevalence of electrocardiographic findings indicative for myocardial ischemia in asymptomatic athletes undergoing pre-participation screening. Myocardial perfusion scintigraphy is generally considered a valuable diagnostic and prognostic modality and often used for further diagnostic evaluation in these subjects. However, data on the diagnostic accuracy of myocardial perfusion scintigraphy in athletes are scarce.
Objectives
The main purpose of this study was to investigate the positive predictive value of myocardial perfusion scintigraphy for detection of coronary artery disease in asymptomatic athletes with abnormal exercise testing results during pre-participation screening. The secondary aim was to evaluate the prognostic value of myocardial perfusion scintigraphy.
Methods
Electronic charts of asymptomatic athletes who underwent myocardial perfusion scintigraphy following an abnormal exercise testing were retrospectively reviewed. Myocardial perfusion scintigraphy and exercise testing studies were revised. Athlete characteristics and cardiovascular risk factors were evaluated.
Results
One hundred and forty-three athletes were included. 29 athletes (20%) showed concordant abnormal exercise testing and myocardial perfusion scintigraphy results. Coronary imaging was performed in 20 of these 29 athletes. Four athletes showed significant coronary artery disease (positive predictive value = 20%). The positive predictive value increased to 33% when athletes were selected who should have undergone exercise testing according to the guideline recommendations. During a mean follow-up interval of 4.7 ± 2.2 years, eight cardiac events occurred. Athletes with an abnormal myocardial perfusion scintigraphy result had a fourfold increased risk at a future cardiac event (2.9%/year versus 0.75%/year, p = 0.031).
Conclusions
The positive predictive value of myocardial perfusion scintigraphy for the detection of significant coronary artery disease in asymptomatic athletes with a positive exercise testing result is low, even in a selection of athletes with a relatively high cardiovascular risk. Although an abnormal myocardial perfusion scintigraphy result was associated with a fourfold higher annual event rate, the absolute annual event rate in this group was still low. Efforts should be made to develop better diagnostic strategies to evaluate asymptomatic athletes with abnormal exercise testing results during pre-participation screening.</description><subject>Adult</subject><subject>Athletes</subject><subject>Computed Tomography Angiography</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Circulation</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - diagnostic imaging</subject><subject>Myocardial Ischemia - mortality</subject><subject>Myocardial Ischemia - physiopathology</subject><subject>Myocardial Ischemia - therapy</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>Organophosphorus Compounds - administration & dosage</subject><subject>Organotechnetium Compounds - administration & dosage</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Radiopharmaceuticals - administration & dosage</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><issn>2047-4873</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1UD1PwzAUtBCIotKdCXlkCdixY7sjqviSKrGUOXJsp3GVxMF2BPn3uGrpgMS94T353Z38DoAbjO4x5vwhR5RTwQnmbEkwKc7A1f4po0Lg89PMyQwsQtihBIbyXIhLMMsFFoxSegXaTWOgtnLbuxCtglKp0Us1QVfDbnJK-rRs4WB8PQbrehiU7aPdejk0E7Q9lLFpTTQBftnYQFn1zndJYL6NVzYYmFYRehPGNoZrcFHLNpjFsc_Bx_PTZvWard9f3laP60wRwmOmqSKyYjhVneulEJwVukIYsVzwpSYVkYJqUTBTs1prLlFeVEVBsakITyBzcHfwHbz7HNMHys4GZdpW9saNoUzH84JykjAH6EBV3oXgTV0O3nbSTyVG5T7m8m_MSXJ7dB-rzuiT4DfURMgOhCC3pty50ffp2v8NfwD7vIXc</recordid><startdate>201706</startdate><enddate>201706</enddate><creator>van de Sande, Danny AJP</creator><creator>Liem, Ing Han</creator><creator>Hoogsteen, Jan</creator><creator>Kemps, Hareld MC</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201706</creationdate><title>The diagnostic accuracy of myocardial perfusion scintigraphy in athletes with abnormal exercise test results</title><author>van de Sande, Danny AJP ; Liem, Ing Han ; Hoogsteen, Jan ; Kemps, Hareld MC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-d4c3ab61616f2d988765db01062879d3b3a84d856ef6fdd7a025b5541eb377773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Athletes</topic><topic>Computed Tomography Angiography</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary Circulation</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - diagnostic imaging</topic><topic>Myocardial Ischemia - mortality</topic><topic>Myocardial Ischemia - physiopathology</topic><topic>Myocardial Ischemia - therapy</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>Organophosphorus Compounds - administration & dosage</topic><topic>Organotechnetium Compounds - administration & dosage</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Radiopharmaceuticals - administration & dosage</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van de Sande, Danny AJP</creatorcontrib><creatorcontrib>Liem, Ing Han</creatorcontrib><creatorcontrib>Hoogsteen, Jan</creatorcontrib><creatorcontrib>Kemps, Hareld MC</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van de Sande, Danny AJP</au><au>Liem, Ing Han</au><au>Hoogsteen, Jan</au><au>Kemps, Hareld MC</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The diagnostic accuracy of myocardial perfusion scintigraphy in athletes with abnormal exercise test results</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><date>2017-06</date><risdate>2017</risdate><volume>24</volume><issue>9</issue><spage>1000</spage><epage>1007</epage><pages>1000-1007</pages><issn>2047-4873</issn><eissn>2047-4881</eissn><abstract>Background
Previous studies revealed a relatively high prevalence of electrocardiographic findings indicative for myocardial ischemia in asymptomatic athletes undergoing pre-participation screening. Myocardial perfusion scintigraphy is generally considered a valuable diagnostic and prognostic modality and often used for further diagnostic evaluation in these subjects. However, data on the diagnostic accuracy of myocardial perfusion scintigraphy in athletes are scarce.
Objectives
The main purpose of this study was to investigate the positive predictive value of myocardial perfusion scintigraphy for detection of coronary artery disease in asymptomatic athletes with abnormal exercise testing results during pre-participation screening. The secondary aim was to evaluate the prognostic value of myocardial perfusion scintigraphy.
Methods
Electronic charts of asymptomatic athletes who underwent myocardial perfusion scintigraphy following an abnormal exercise testing were retrospectively reviewed. Myocardial perfusion scintigraphy and exercise testing studies were revised. Athlete characteristics and cardiovascular risk factors were evaluated.
Results
One hundred and forty-three athletes were included. 29 athletes (20%) showed concordant abnormal exercise testing and myocardial perfusion scintigraphy results. Coronary imaging was performed in 20 of these 29 athletes. Four athletes showed significant coronary artery disease (positive predictive value = 20%). The positive predictive value increased to 33% when athletes were selected who should have undergone exercise testing according to the guideline recommendations. During a mean follow-up interval of 4.7 ± 2.2 years, eight cardiac events occurred. Athletes with an abnormal myocardial perfusion scintigraphy result had a fourfold increased risk at a future cardiac event (2.9%/year versus 0.75%/year, p = 0.031).
Conclusions
The positive predictive value of myocardial perfusion scintigraphy for the detection of significant coronary artery disease in asymptomatic athletes with a positive exercise testing result is low, even in a selection of athletes with a relatively high cardiovascular risk. Although an abnormal myocardial perfusion scintigraphy result was associated with a fourfold higher annual event rate, the absolute annual event rate in this group was still low. Efforts should be made to develop better diagnostic strategies to evaluate asymptomatic athletes with abnormal exercise testing results during pre-participation screening.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>28186444</pmid><doi>10.1177/2047487317693135</doi><tpages>8</tpages></addata></record> |
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| ispartof | European journal of preventive cardiology, 2017-06, Vol.24 (9), p.1000-1007 |
| issn | 2047-4873 2047-4881 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; SAGE Complete; Alma/SFX Local Collection |
| subjects | Adult Athletes Computed Tomography Angiography Coronary Angiography - methods Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - mortality Coronary Artery Disease - physiopathology Coronary Artery Disease - therapy Coronary Circulation Exercise Test Female Humans Male Middle Aged Myocardial Ischemia - diagnostic imaging Myocardial Ischemia - mortality Myocardial Ischemia - physiopathology Myocardial Ischemia - therapy Myocardial Perfusion Imaging - methods Organophosphorus Compounds - administration & dosage Organotechnetium Compounds - administration & dosage Predictive Value of Tests Prognosis Radiopharmaceuticals - administration & dosage Reproducibility of Results Retrospective Studies Risk Assessment Risk Factors Time Factors |
| title | The diagnostic accuracy of myocardial perfusion scintigraphy in athletes with abnormal exercise test results |
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