[The diagnosis of silent myocardial ischemia. The problems of false-positive findings in the exercise ECG and long-term ECG].
In the case of a disease that produces no complaints, such as silent myocardial ischemia, it is of particular importance not to diagnose--or even to treat--a "pseudo-disease" in a patient with false-positive findings. In assessing whether a finding is false-positive or not, there is no "gold standard" for 24-hour ECG monitoring, since no other technique is capable of detecting transient attacks of ischemia occurring at any time during the day or at night. If only the ECG finding is positive, however, a second independent method is required to confirm the diagnosis. In this it must be remembered that all causes of false positive findings known in the case of exercise ECG also apply to the 24-hour ECG, and that when patients in whom the pre-test probability in accordance with the risk profile is low, the number of false-positive findings is likely to be very high. For these reasons, the 24-hour ECG cannot be recommended as a screening procedure for the diagnosis of ischemic heart disease.
von Arnim
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I. Medizinische Klinik, Krankenanstalten Rotes Kreuz, München.
D001499:Bayes Theorem; D003327:Coronary Disease / Q000175:diagnosis*; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005189:False Positive Reactions; D006801:Humans
Diagnose der stummen Myokardischämie. Problematik falsch-positiver Befunde in Belastungs- und Langzeit-EKG.