Abstract
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Objectives To estimate the proportion of subjects (without a history of coronary artery disease, without typical chest pain, and <203 lb for men and <175 lb for women) who have a change in diagnosis as a result of rest imaging.
Methods In 171 retrospective chart reviews, 50 subjects met inclusion criteria. Subsequently, pharmaceutical induced Tc-99m MPS (Myocardial Perfusion Scintigraphy) was performed. 4 ABNM certified physicians were randomly assigned 12-13 patients. They first read the pharmaceutical induced stress only Tc-99m MPS images for their set of patients. Then they read the rest+stress images, for the same patients. Images were in random order without identifiers. Results were classified as Normal, Equivocal or Abnormal. For all readers, 2 normal, 2 equivocal and 2 abnormal diagnostic images were inserted into the rests+stress set to prevent recollection bias.
Results Gender was associated with a significant change in results (p<0.001). 44% of males were upgraded compared to 4% of females. We examined if age, smoking history, gender adjusted weight and rater were associated with a change in category and did not find any significant differences. The agreement statistics for clinically relevant change (normal vs. equivocal/abnormal) for males differed significantly from that for females (Kappa=0.096 vs. 0.702, p=0.016). The agreement was 52% for males and 92% for females with males having a significant difference in the distribution of diagnoses for Stress Only vs. Rests and Stress readings (p=0.021), whereas females did not (p=1.00).
Conclusions In our study, 95.2% (95% CI, 76.2-99.9%) of <175 lb women, without a history of coronary artery disease, and without typical chest pain, who have a normal stress MPS, will not have a change in diagnosis by performing resting MPS
Results of Stress testing and Rest and Stress testing according to Gender
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