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Methodologic Problems in Exercise Testing ResearchAre We Solving Them?
Robert Detrano, MD, PhD;
Kenneth P. Lyons, MD;
Gilberto Marcondes, MD;
Nabil Abbassi, MD;
Victor F. Froelicher, MD;
Andras Janosi, MD
Arch Intern Med. 1988;148(6):1289-1295.
Abstract
• To evaluate the comparative effects of methodologic factors on the reported accuracies of two standard exercise tests, 56 publications comparing the exercise thallium scintigram with the coronary angiogram were analyzed for conformation to five methodologic standards. Analyzed were adequate definition of study group, avoidance of a limited challenge group, avoidance of workup bias, and blinded analysis of the coronary angiogram and myocardial scintigram. Study group characteristics and technical factors were also reviewed. Better conformation with methodologic standards was found than has been reported previously for treadmill exercise testing. Furthermore, study group characteristics and technical factors were better predictors of sensitivity and specificity than were methodologic deficiencies. Only workup bias and test blinding were significantly associated with test accuracy. The percentage of patients with previous myocardial infarction had the highest correlation and was independently and directly related to sensitivity and inversely related to specificity.
(Arch Intern Med 1988;148:1289-1295)
Author Affiliations
From the Long Beach (Calif) Veterans Administration Medical Center (Drs Detrano, Lyons, Marcondes, Abbassi, and Froelicher) and the Hungarian Institute of Cardiology, Budapest (Dr Janosi). Dr Janosi was a traveling fellow sponsored by the National Institutes of Health, Bethesda, Md.
Footnotes
Accepted for publication Oct 13, 1987.
Reprint requests to Long Beach Veterans Administration Medical Center, 5901 E Seventh St, Long Beach, CA 90822 (Dr Detrano).
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