Abstract
The Diamond-Forrester (DF) algorithm overestimates the likelihood of significant coronary artery disease (≥50% stenosis, CAD50). The aim of the present study was to evaluate whether the addition of a diagonal earlobe crease (DELC) enhances the predictive ability of DF to detect CAD50 by coronary computed tomographic angiography (CTA). We evaluated 430 patients referred for CTA for symptoms, cardiovascular risk factors, and CAD50 likelihood using DF. Observers blinded to CTA findings evaluated the presence of DELC. The diagnostic accuracy and relation of DF, DELC, and DF + DELC for predicting CAD50 in patients with chest pain were evaluated using receiver operating characteristics curve (area under curve) analyses and multivariate logistic regression analyses. In 199 patients with chest pain, the sensitivity and specificity for CAD50 were 96% and 20% for DF (AUC 0.59, p = 0.59), 91% and 32% for DELC (AUC 0.62, p = 0.03), and 91% and 41% for DF + DELC (AUC 0.66, p = 0.004). On multivariate analyses DELC was the only independent predictor of CAD50 (odds ratio 3.6, 95% confidence interval 1 to 12.9, p = 0.048). DF + DELC increased the predictive ability to detect CAD50 above cardiovascular risk factors (odds ratio 5.6, 95% confidence interval 1.6 to 19.8, p = 0.007). In patients with chest pain, the presence of DELC is related to CAD50 beyond DF. A combined variable of DF + DELC provides superior discriminatory ability for detecting CAD50 than either method alone.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1670-1675 |
| Number of pages | 6 |
| Journal | American Journal of Cardiology |
| Volume | 114 |
| Issue number | 11 |
| DOIs | |
| State | Published - Dec 1 2014 |
Fingerprint
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Medicine(all)
Cite this
Incremental value of diagonal earlobe crease to the diamond-forrester classification in estimating the probability of significant coronary artery disease determined by computed tomographic angiography. / Shmilovich, Haim; Cheng, Victor Y.; Nakazato, Ryo; Smith, Thomas W R; Otaki, Yuka; Nakanishi, Rine; Paz, William; Pimentel, Raymond T.; Berman, Daniel S.; Rajani, Ronak.
In: American Journal of Cardiology, Vol. 114, No. 11, 01.12.2014, p. 1670-1675.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Incremental value of diagonal earlobe crease to the diamond-forrester classification in estimating the probability of significant coronary artery disease determined by computed tomographic angiography
AU - Shmilovich, Haim
AU - Cheng, Victor Y.
AU - Nakazato, Ryo
AU - Smith, Thomas W R
AU - Otaki, Yuka
AU - Nakanishi, Rine
AU - Paz, William
AU - Pimentel, Raymond T.
AU - Berman, Daniel S.
AU - Rajani, Ronak
PY - 2014/12/1
Y1 - 2014/12/1
N2 - The Diamond-Forrester (DF) algorithm overestimates the likelihood of significant coronary artery disease (≥50% stenosis, CAD50). The aim of the present study was to evaluate whether the addition of a diagonal earlobe crease (DELC) enhances the predictive ability of DF to detect CAD50 by coronary computed tomographic angiography (CTA). We evaluated 430 patients referred for CTA for symptoms, cardiovascular risk factors, and CAD50 likelihood using DF. Observers blinded to CTA findings evaluated the presence of DELC. The diagnostic accuracy and relation of DF, DELC, and DF + DELC for predicting CAD50 in patients with chest pain were evaluated using receiver operating characteristics curve (area under curve) analyses and multivariate logistic regression analyses. In 199 patients with chest pain, the sensitivity and specificity for CAD50 were 96% and 20% for DF (AUC 0.59, p = 0.59), 91% and 32% for DELC (AUC 0.62, p = 0.03), and 91% and 41% for DF + DELC (AUC 0.66, p = 0.004). On multivariate analyses DELC was the only independent predictor of CAD50 (odds ratio 3.6, 95% confidence interval 1 to 12.9, p = 0.048). DF + DELC increased the predictive ability to detect CAD50 above cardiovascular risk factors (odds ratio 5.6, 95% confidence interval 1.6 to 19.8, p = 0.007). In patients with chest pain, the presence of DELC is related to CAD50 beyond DF. A combined variable of DF + DELC provides superior discriminatory ability for detecting CAD50 than either method alone.
AB - The Diamond-Forrester (DF) algorithm overestimates the likelihood of significant coronary artery disease (≥50% stenosis, CAD50). The aim of the present study was to evaluate whether the addition of a diagonal earlobe crease (DELC) enhances the predictive ability of DF to detect CAD50 by coronary computed tomographic angiography (CTA). We evaluated 430 patients referred for CTA for symptoms, cardiovascular risk factors, and CAD50 likelihood using DF. Observers blinded to CTA findings evaluated the presence of DELC. The diagnostic accuracy and relation of DF, DELC, and DF + DELC for predicting CAD50 in patients with chest pain were evaluated using receiver operating characteristics curve (area under curve) analyses and multivariate logistic regression analyses. In 199 patients with chest pain, the sensitivity and specificity for CAD50 were 96% and 20% for DF (AUC 0.59, p = 0.59), 91% and 32% for DELC (AUC 0.62, p = 0.03), and 91% and 41% for DF + DELC (AUC 0.66, p = 0.004). On multivariate analyses DELC was the only independent predictor of CAD50 (odds ratio 3.6, 95% confidence interval 1 to 12.9, p = 0.048). DF + DELC increased the predictive ability to detect CAD50 above cardiovascular risk factors (odds ratio 5.6, 95% confidence interval 1.6 to 19.8, p = 0.007). In patients with chest pain, the presence of DELC is related to CAD50 beyond DF. A combined variable of DF + DELC provides superior discriminatory ability for detecting CAD50 than either method alone.
UR - http://www.scopus.com/inward/record.url?scp=84912114690&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84912114690&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2014.08.036
DO - 10.1016/j.amjcard.2014.08.036
M3 - Article
C2 - 25288500
AN - SCOPUS:84912114690
VL - 114
SP - 1670
EP - 1675
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 11
ER -