scholarly journals Time to step up 4 flights of stairs gives relevant information on exercise testing performance and results

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
JC Peteiro Vazquez ◽  
A Bouzas-Mosquera ◽  
C Rivadulla-Varela ◽  
C Barbeito-Caamano ◽  
JM Vazquez-Rodriguez
Keyword(s):  
Exercise Capacity ◽  
Exercise Testing ◽  
Test Performance ◽  
Predictive Value ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
High Specificity ◽  
Cardiac Events ◽  
Predictive Values ◽  
Metabolic Equivalents

Abstract Funding Acknowledgements Type of funding sources: None. Background The achievement of a maximal workload of 10 metabolic equivalents (METs) is associated to good outcome with hard cardiac events of just around 1%/year. However, there is no much information on common daily exercises that can be quantitatively measured and give information about this exercise performance. We aimed to assess the capacity of stepping up stairs in patients submitted for an exercise testing (ExT). Methods A total of 165 consecutive ambulatory patients submitted for a clinically indicated ExT with ECG (ExT-ECG, n = 15) or echocardiography (ExT-E, n = 150) were included. At least 15 minutes after the test patients were asked to step up 4 flights of stairs (60 stairs) at fast pace without stopping but also without running and the time to do it was counted. Results Patients who achieved 10 METs during exercise (n = 69) made the stairs test in 46 ± 11 secs, those who achieved 8-10 METs (n = 37) in 58 ± 21 secs, and those who achieved <8 METs (n = 59) made it in 82 ± 41 secs (p < 0.001). Correlation between METs and stairs time test was 0.53 (Figure 1). The area under the curve ROC of stairs time for predicting an achievement of 10 METs was 0.79 (95% CI= 0.72-0.86, p < 0.001). A cut off value of 60 secs had high sensitivity (94%) and negative predictive value for 10 METs (93%) although specificity and positive predictive values were of 53% and 59%, respectively. A cut-off value of 90 secs had low sensitivity (34%) but high specificity (96%) and positive predictive value (83%) for predicting <8 METs. Abnormal results were seen in 58% of patients with limited exercise capacity, 30% with intermediate exercise capacity, and 29% with good exercise capacity (p = 0.002); and in 32% of patients that did the stairs test in at least 60 secs in comparison with 52% of those that lasted between 61-89 secs and 58% of those that lasted more (p = 0.018). Conclusions Most subjects able to step up 4 flights of stairs in 45 secs will perform well during exercise testing. On the contrary, those unable to make the stairs test in 1 and a half minutes are expected to have bad functional capacity and worse exercise test performance. Abstract Figure.

Evaluation of the clinical usefulness of a chemiluminometric method for measuring creatine kinase MB

1990 ◽  
Vol 36 (10) ◽  
pp. 1809-1811 ◽  
Author(s):  
J R Pearson ◽  
F Carrea
Keyword(s):  
Creatine Kinase ◽  
Predictive Value ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
High Specificity ◽  
Receiver Operator Characteristic Curve ◽  
Diagnostic Efficiency ◽  
Predictive Values ◽  
Creatine Kinase Mb ◽  
Rule Out

Abstract The use of creatine kinase isoenzymes (CK-MB) in the diagnosis of acute myocardial infarction (AMI) is well established. We evaluated the use of a new chemiluminometric method (CK-Ciba) for measuring CK-MB by calculating its sensitivity, specificity, positive and negative predictive values, and diagnostic efficiency for diagnosing AMI. We tested 633 samples from 229 patients within 4 h of receipt. The patients were divided into four groups: (1) patients who had an AMI, (2) patients who had AMI ruled out, (3) patients who had CK-MB measured for reasons other than to rule out AMI, and (4) patients who had only one sample drawn. Only patients in Groups 1 and 2 were used in the study. AMI was diagnosed by a cardiologist. The prevalence of AMI in our population was 0.18. A receiver-operator characteristic curve was used to establish optimal values for identifying AMI with the CK-Ciba results: CK-MB greater than or equal to 10 micrograms/L and a CK-MB index of greater than or equal to 3.0 (micrograms of CK-MB per U of CK x 100). Using these values, we calculated a sensitivity of 1.00, specificity of 0.97, positive predictive value of 0.87, negative predictive value of 1.00, and a diagnostic efficiency of 0.97. We conclude that the CK-Ciba method has high sensitivity, high specificity, and good predictive values for CK-MB and is appropriate to use to rule out AMI.

scholarly journals Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 109 ◽  
Author(s):  
Ukweh ◽  
Ugbem ◽  
Okeke ◽  
Ekpo
Keyword(s):  
Predictive Value ◽  
Performance Metrics ◽  
Area Under The Curve ◽  
Youden Index ◽  
Likelihood Ratios ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Resource Setting ◽  
Post Test ◽  
Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

scholarly journals The Duke treadmill score with bicycle ergometer: Exercise capacity is the most important predictor of cardiovascular mortality

2018 ◽  
Vol 26 (2) ◽  
pp. 199-207 ◽  
Author(s):  
Esko Salokari ◽  
Jari A Laukkanen ◽  
Terho Lehtimaki ◽  
Sudhir Kurl ◽  
Setor Kunutsor ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Exercise Testing ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Bicycle Exercise ◽  
Metabolic Equivalents ◽  
Ergometer Exercise ◽  
Duke Treadmill Score

Background The Duke treadmill score, a widely used treadmill testing tool, is a weighted index combining exercise time or capacity, maximum ST-segment deviation and exercise-induced angina. No previous studies have investigated whether the Duke treadmill score and its individual components based on bicycle exercise testing predict cardiovascular death. Design Two populations with a standard bicycle testing were used: 3936 patients referred for exercise testing (2371 men, age 56 ± 13 years) from the Finnish Cardiovascular Study (FINCAVAS) and a population-based sample of 2683 men (age 53 ± 5.1 years) from the Kuopio Ischaemic Heart Disease study (KIHD). Methods Cox regression was applied for risk prediction with cardiovascular mortality as the primary endpoint. Results In FINCAVAS, during a median 6.3-year (interquartile range (IQR) 4.5–8.2) follow-up period, 180 patients (4.6%) experienced cardiovascular mortality. In KIHD, 562 patients (21.0%) died from cardiovascular causes during the median follow-up of 24.1 (IQR 18.0–26.2) years. The Duke treadmill score was associated with cardiovascular mortality in both populations (FINCAVAS, adjusted hazard ratio (HR) 3.15 for highest vs. lowest Duke treadmill score tertile, 95% confidence interval (CI) 1.83–5.42, P < 0.001; KIHD, adjusted HR 1.71, 95% CI 1.34–2.18, P < 0.001). However, after progressive adjustment for the Duke treadmill score components, the score was not associated with cardiovascular mortality in either study population, as exercise capacity in metabolic equivalents of task was the dominant harbinger of poor prognosis. Conclusions The Duke treadmill score is associated with cardiovascular mortality among patients who have undergone bicycle exercise testing, but metabolic equivalents of task, a component of the Duke treadmill score, proved to be a superior predictor.

scholarly journals Evaluating Specivity, Sensitivity, Positive and Negative Predictive Values of CA125 for Diagnosing Ovarian Cancer

2021 ◽  
Vol 24 (2) ◽  
pp. 196-203
Author(s):  
Elahe Fini ◽  
◽  
Neda Nasirian ◽  
Bahram Hosein Beigy ◽  
◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Positive Predictive Value ◽  
Tumor Marker ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
High Sensitivity ◽  
Medical Community ◽  
Cross Sectional ◽  
Predictive Values

Background and Aim: Ovarian cancer is among the most common cancers in women worldwide. CA125 is the most frequent biomarker used in the screening for ovarian cancer. CA125 has no high sensitivity and specificity as a screening test in the medical community; however, because of being simple and noninvasive, it is almost always requested for evaluation and ruling out cancer. It plays an important role in the treatment and post-treatment process, the prediction of prognosis, and the relapse of the disease. The present study aimed to determine the relationship between a high level of CA125 tumor marker and ovarian cancer by detecting spesivity, sensivity, positive and negative predictive values. Methods & Materials: In this cross-sectional study, all cases undergoing CA125 test in Velayat Hospital in 2017-1028 were evaluated for having ovarian cancer. In addition, the CA125 level was compared between healthy individuals and patients with ovarian cancer. Finally, the obtained data were analyzed using SPSS. Ethical Considerations: The present study was approved by the Qazvin University of Medical Sciences (Ethics Code: IR.QUMS.REC.1396.316). Results: In this study, 35.3% of the study participants received a definite diagnosis of ovarian cancer. Generally, CA125 values were negative in 41.8% and positive in.58.2% of the study subjects. The sensitivity of the test was measured as 80.1%, the specivity as 53.6%, the positive predictive value equaled 48.4%, and the negative predictive value was measured as 83%. There was a significant relationship between age and the presence of ovarian cancer, and serum CA125 levels. Conclusion: The present study suggested that age and the serum level of CA125 were statistically significant. Finally, CA125 levels were significantly related to ovarian cancer. It provided moderate specivity and specivity as well as low positive predictive value and high negative predictive value as a tumor marker; it is valuable for ruling out of tumor but not appropriate as a screening test.

Abstract 17352: Hand Grip Strength as a Predictor of Exercise Capacity in Coronary Heart Disease

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Cheol Ung Choi ◽  
Woohyeun Kim ◽  
Se-Hyun Park ◽  
Woo-Sub Kim ◽  
Won Young Jang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Grip Strength ◽  
Exercise Capacity ◽  
Quadriceps Strength ◽  
Hand Grip Strength ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Metabolic Equivalents ◽  
Hand Grip

Introduction: Exercise capacity is related to the prognosis of coronary heart disease (CHD). Recent study have shown that quadriceps strength can be used to predict exercise capacity levels in patients with CHD. Hypothesis: The aim of this study is to determine whether this relationship between muscular strength and exercise capacity is maintained in hand grip strength (HGS). Methods: We studied 310 participants (Age; 62.1 ± 11.5, Men; 77.4 %) who underwent coronary intervention and participated cardiac rehabilitation. Maximal HGS was expressed as absolute value (kg), and relative to bodyweight (%bodyweight). Logistic regression was used to assess the relationship of maximal HGS, age, sex, type of CHD, diabetes, hypertension, renal insufficiency, ejection fraction, body mass index, body weight, waist to hip ratio, and basal metabolic rate with distance walked on 6-minuite walk test (6MWT) and estimated metabolic equivalents (eMETs). Results: Maximal HGS was significantly related to distance walked on 6 MWT (r = 0.40 for %bodyweight, p < 0.001) and eMETs (r = 0.43 for %bodyweight, p < 0.001). Maximal HGS was the strongest predictor of exercise capacity in each distance walked on 6 MWT category. Receiver operating characteristics curves identified maximal HGS of 35.7, 42.0% bodyweight as the best predictive cut offs for 200, and 400 meters, respectively with positive predictive values of 0.64. They also identified HGS of 38.3, and 44.6% bodyweight as the best predictive cut offs for 6 and 8 eMETs, respectively with positive predictive values of 0.70. Conclusions: Maximal HGS is related with distance on 6 MWT and eMETs levels at exercise test in CHD patients. This result suggests that maximal HGS can be used to predict exercise capacity levels. Based on this result, prospective study investigating the association between HGS and clinical outcome of CHD is needed.

scholarly journals Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Konuralp Yakar
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Performance ◽  
High Specificity ◽  
Screening Criteria ◽  
Predictive Values ◽  
Before And After ◽  
Sensitivity Specificity ◽  
Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

scholarly journals Diagnostic Performance of Bronchoalveolar Lavage (1,3)-β-d-Glucan Assay for Pneumocystis jirovecii Pneumonia

2020 ◽  
Vol 6 (4) ◽  
pp. 200
Author(s):  
Shiwei Zhou ◽  
Kathleen A. Linder ◽  
Carol A. Kauffman ◽  
Blair J. Richards ◽  
Steve Kleiboeker ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Test Performance ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Lavage Fluid ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Characteristic Area

We evaluated the performance of the (1,3)-β-d-glucan (BDG) assay on bronchoalveolar lavage fluid (BALF) as a possible aid to the diagnosis of Pneumocystis jirovecii pneumonia. BALF samples from 18 patients with well-characterized proven, probable, and possible Pneumocystis pneumonia and 18 well-matched controls were tested. We found that the best test performance was observed with a cut-off value of 128 pg/mL; receiver operating characteristic/area under the curve (ROC/AUC) was 0.70 (95% CI 0.52–0.87). Sensitivity and specificity were 78% and 56%, respectively; positive predictive value was 64%, and negative predictive value was 71%. The low specificity that we noted limits the utility of BALF BDG as a diagnostic tool for Pneumocystis pneumonia.

scholarly journals Quantitative Thresholds Enable Accurate Identification ofClostridium difficileInfection by the Luminex xTAG Gastrointestinal Pathogen Panel

2018 ◽  
Vol 56 (6) ◽  
Author(s):  
Sixto M. Leal ◽  
Elena B. Popowitch ◽  
Kara J. Levinson ◽  
Teny M. John ◽  
Bethany Lehman ◽  
...  
Keyword(s):  
Test Performance ◽  
Predictive Value ◽  
High Specificity ◽  
Clinical Suspicion ◽  
Performance Characteristics ◽  
Accurate Identification ◽  
Data Set ◽  
Content Type ◽  
Molecular Assays ◽  
Stool Samples

ABSTRACTClostridium difficilecolonizes the gastrointestinal (GI) tract, resulting in either asymptomatic carriage or a spectrum of diarrheal illness. If clinical suspicion forC. difficileis low, stool samples are often submitted for analysis by multiplex molecular assays capable of detecting multiple GI pathogens, and some institutions do not report this organism due to concerns for high false-positive rates. Since clinical disease correlates with organism burden and molecular assays yield quantitative data, we hypothesized that numerical cutoffs could be utilized to improve the specificity of the Luminex xTAG GI pathogen panel (GPP) forC. difficileinfection. Analysis of cotested liquid stool samples (n= 1,105) identified a GPP median fluorescence intensity (MFI) value cutoff of ≥1,200 to be predictive of two-step algorithm (2-SA; 96.4% concordance) and toxin enzyme immunoassay (EIA) positivity. Application of this cutoff to a second cotested data set (n= 1,428) yielded 96.5% concordance. To determine test performance characteristics, concordant results were deemed positive or negative, and discordant results were adjudicated via chart review. Test performance characteristics for the MFI cutoff of ≥150 (standard), MFI cutoff of ≥1,200, and 2-SA were as follows (respectively): concordance, 95, 96, and 97%; sensitivity, 93, 78, and 90%; specificity, 95, 98, and 98%; positive predictive value, 67, 82, and 81%;, and negative predictive value, 99, 98, and 99%. To capture the high sensitivity for organism detection (MFI of ≥150) and high specificity for active infection (MFI of ≥1,200), we developed and applied a reporting algorithm to interpret GPP data from patients (n= 563) with clinician orders only for syndromic panel testing, thus enabling accurate reporting ofC. difficilefor 95% of samples (514 negative and 5 true positives) irrespective of initial clinical suspicion and without the need for additional testing.

Epstein-Barr Virus (EBV)-Encoded RNA: Automated In-Situ Hybridization (ISH) Compared with Manual ISH and Immunohistochemistry for Detection of EBV in Pediatric Lymphoproliferative Disorders

2009 ◽  
Vol 12 (3) ◽  
pp. 195-199 ◽  
Author(s):  
Naim K. Fanaian ◽  
Cynthia Cohen ◽  
Sandra Waldrop ◽  
Jennifer Wang ◽  
Bahig M. Shehata
Keyword(s):  
In Situ Hybridization ◽  
Predictive Value ◽  
Epstein Barr Virus ◽  
High Sensitivity ◽  
High Specificity ◽  
Lymphoproliferative Disorders ◽  
Barr Virus ◽  
Epstein Barr ◽  
Low Sensitivity

Detection of Epstein-Barr virus (EBV) may be achieved by various methods, including EBV-encoded RNA (EBER) in-situ hybridization (ISH) and immunohistochemistry (IHC) for latent membrane protein (LMP-1). We compared novel automated ISH and IHC techniques in pediatric lymphoproliferative disorders with results obtained by manual ISH. Thirty-seven pediatric cases previously studied by manual EBER ISH (including 18 EBER-positive, 15 EBER-negative, and 4 EBER-equivocal cases) were used for the study. Automated EBER ISH and automated LMP-1 IHC were performed using the BondMax autostainer and prediluted EBER probe and EBV cell surface 1 to 4 at 1:50 dilution, respectively. Results of each of the automated techniques for EBV detection were compared with results by manual EBER ISH. Compared with manual EBER ISH as the gold standard, automated ISH had a sensitivity and specificity of 94% and 69%, respectively, accuracy of 83%, positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 90%. Automated IHC had a sensitivity of 44%, specificity of 93%, accuracy of 67%, PPV of 88%, and NPV of 59%. Automated ISH and IHC correlated significantly ( P < 0.045). Automated ISH is useful for diagnosis of EBV-related pediatric neoplasms, being easy to perform and interpret and requiring only the technologist's time to set up and having a high sensitivity and NPV. The automated IHC protocol is of too low sensitivity for routine use, although results show high specificity and PPV.

scholarly journals Biomarkers In Acute Heart Failure — Cardiac And Kidney

2015 ◽  
Vol 1 (2) ◽  
pp. 107 ◽  
Author(s):  
A Mark Richards ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Test Performance ◽  
Acute Decompensated Heart Failure ◽  
Unmet Need ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Decompensated Heart Failure ◽  
Predictive Values

Natriuretic peptides (NP) are well-validated aids in the diagnosis of acute decompensated heart failure (ADHF). In acute presentations, both brain natriuretic peptide (BNP) and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) offer high sensitivity (>90 %) and negative predictive values (>95 %) for ruling out ADHF at thresholds of 100 and 300 pg/ml, respectively. Plasma NP rise with age. For added rule-in performance age-adjusted thresholds (450 pg/ml for under 50 years, 900 pg/ml for 50—75 years and 1,800 pg/ml for those >75 years) can be applied to NT-proBNP results. Test performance (specificity and accuracy but not sensitivity) is clearly reduced by renal dysfunction and atrial fibrillation. Obesity offsets the threshold downwards (to ~50 pg/ml for BNP), but overall discrimination is preserved. Reliable markers for impending acute kidney injury in ADHF constitute an unmet need, with candidates, such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin, failing to perform sufficiently well, and new possibilities, including the cell cycle markers insulin growth factor binding protein 7 and tissue inhibitor of metalloproteinases type 2, remain the subject of research.

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