Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients.

BACKGROUND: Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. METHODS: Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old). The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. RESULTS: Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05) in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746) and 0.655 (95% CI: 0.584-0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. CONCLUSIONS: The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

[Correlation between Duke treadmill score and corrected thrombolysis in myocardial infarction frame count in patients with coronary atherosclerotic heart disease].

OBJECTIVE: To investigate the correlation between Duke treadmill score (DTS) and corrected thrombolysis in myocardial infarction frame count(CTFC )in patients with coronary atherosclerotic heart disease(CAD). METHODS: Seventy-two patients with coronary atherosclerotic heart disease, who underwent treadmill exercise tests in 2 weeks before coronary angiography were enrolled in our study. All the patients were divided into 2 groups according to the value of DTS: low-risk group (DTS > or = 5) and moderate-high-risk group (DTS < 5). We evaluated the correlation between DTS and CTFC and compared the differences between the two groups. RESULTS: DTS had a negative correlation with CTFC of left anterior descending branch (LAD), left circumflex artery (LCX) and right coronary artery (RCA)(r = -0.821,-0.730,-0.598, P<0.001). CTFC of all coronary arteries in the low-risk group was much lower than that of moderate-high-risk group [LAD: (22.27+/-3.71) frames vs (24.12+/-4.19) frames, respectively; LCX: (27.96+/-5.65) frames vs (31.28+/- 6.79) frames, respectively; RCA: (21.96+/-5.85) frames vs (24.64+/-7.33) frames, respectively], there was significant difference between the two groups. CONCLUSION: There was a negative correlation between DTS and CTFC of left anterior descending branch, left circumflex artery and right coronary artery in patients with CAD. The risk stratification on the basis of DTS had a notable association with CTFC. These results may provide a theoretical evidence for utilizing the non-invasive method DTS to evaluate prognosis of patients with CAD.

[Association of QT dispersion, ST/heart rate slope and ST-segment depression in exercise test to evaluate restenosis after percutaneous coronary intervention].

OBJECTIVE: To evaluate the sensitivity and specificity of QT dispersion (QTd) and ST/heart rate slope (ST/HRs) at the end of ECG exercise test plus ST-segment depression on diagnosing restenosis after percutaneous coronary intervention (PCI). METHODS: Between November 2001 and December 2003, 129 patients underwent PCI successfully, and they were examined 3-6 months later. At the end of treadmill exercise, QTd and ST/HRs were measured. All patients also accepted coronary angiography to ascertain whether he/she had restenosis. The results of QTd and ST/HRs plus ST-segment depression were then evaluated. RESULTS: The sensitivity and specificity of QTd and ST/HRs plus ST-segment depression were 84.6% and 80.4% respectively. Both of them were significantly higher than conventional ST-segment depression standard (sensitivity was 53.3% and specificity was 66.7%, P<0.05). CONCLUSION: Measuring QTd and ST/HRs at the end of ECG treadmill exercise test plus ST-segment depression can be used for the diagnosis of restenosis after PCI.

[The effects of gender on heart rate adjustment of ST segment depression for identifying coronary arteriosclerosis disease].

OBJECTIVE: To assess the effects of gender on heart rate adjustment of ST segment depression (ST/HR) for identifying coronary arteriosclerotic disease. METHODS: One hundred and seventy three patients with suspected coronary disease (CAD) were referred for a routine treadmill exercise electrocardiogram and subsequently they underwent selective coronary angiography within 3 weeks. The magnitude of ST segment depression, ST/HR slope and calculated ST/HR index are performed by a computerized ECG system; exercise was performed according to the cornell protocol. CAD was defined by coronary angiography. We divided the patients into two groups by gender. RESULTS: Sensitivity and specificity for identifying CAD with ST/HR slope and ST/HR index were all significantly greater than that of standard electrocardiographic test criteria (P <0.05). Compared with standard criteria, the sensitivity for identifying CAD of ST/HR slope and ST/HR index increased 23% and 16% in men, 50% and 42% in women respectively; all difference were statistically significant (P <0.05). The specificity for identifying CAD with ST/HR slope and ST/HR index increased 58% and 50% in women, with no increase in men. CONCLUSIONS: It is suggested that sensitivity and specificity for identifying CAD with ST/HR slope and ST/HR index were all significantly higher than those with standard electrocardiographic test criteria in selected women patients. Sensitivity were significantly increased in selected men patients, with no significant change in specificity.