Letter to the Editor
Diagnostic and prognostic performance of 24-hour Holter in patients with unrecorded syncope
Rendimiento diagnóstico y pronóstico del Holter de 24 horas en pacientes con síncope no aclarado
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Of the total of 6006 patients, 564 (9.4%) met the primary endpoint. Also, 242 patients (4.0%) had diagnostic findings on Holter monitoring, and the likelihood of diagnostic findings increased in those over 80 years of age and in patients with ejection fraction lower than 35%.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Of the 564 patients who met the primary endpoint, 89 had diagnostic findings, that is, a 36.8% (89 of 242 patients), and 475 showed no diagnostic findings in Holter monitoring, representing 8.2% of those patients (475 of 5764 patients). The sensitivity and specificity for the prediction of device implant in the case of diagnostic findings was 22.6 and 97%, respectively. Finally, the authors concluded that the 24-hour Holter monitoring presents a limited diagnostic and prognostic performance in unselected patients.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, and although they are the most commonly used indices in the medical literature, the usefulness of sensitivity and specificity to evaluate the diagnostic or prognostic performance of a test is limited because they depend heavily on the prevalence of the condition in the population evaluated.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Alternative performance indices such as the positive or negative <span class="elsevierStyleItalic"><span class="elsevierStyleBold">likelihood ratio</span></span> are more useful in interpreting the results of a diagnostic test because they can transform the pre-test probability of having or not certain condition in a post-test probability, and not rely on the prevalence of disease in the group in which the test was evaluated.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> The real utility of a diagnostic test lies in the modification that its result produces in the probability that a patient has a specific condition. Therefore, because they link pre-test probability with post-test probability, likelihood ratios would be the most appropriate indices to evaluate the performance of a diagnostic test.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study, the presence of diagnostic findings in 24-hour Holter monitoring implied that patients who showed abnormalities which were considered diagnostic increased by four the proportion of those who met the primary endpoint (death or implant device at one year) compared to those who did not present diagnostic findings (36.8 versus 8.2%, positive likelihood ratio<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>sensitivity test/[1<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>specificity test]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.226/[1<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>0.97]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7.53).</p><p id="par0030" class="elsevierStylePara elsevierViewall">These facts show that the diagnostic findings determined by 24-hour Holter monitoring allows the detection of a group with much worse prognosis without generating any kind of morbidity, since the 24-hour Holter is a non-invasive test, so it remains an attractive option for the study of patients with syncope of unknown origin.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Shihadeh LA, Lorenzo-González J, Fernández-Rodríguez D. Rendimiento diagnóstico y pronóstico del Holter de 24 horas en pacientes con síncope no aclarado. Med Clin (Barc). 2017;148:479.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rendimiento diagnóstico y pronóstico del registro Holter de 24 horas en pacientes con síncope" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Barbeito-Caamaño" 1 => "G. Sánchez-Fernández" 2 => "A. Bouzas-Mosquera" 3 => "F.J. Broullón" 4 => "N. Álvarez-García" 5 => "J.M. Vázquez-Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2016" "volumen" => "147" "paginaInicial" => "148" "paginaFinal" => "150" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Índices de rendimiento de las pruebas diagnósticas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V. Abraira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semergen" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "193" "paginaFinal" => "194" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014800000010/v1_201706100114/S2387020617303108/v1_201706100114/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014800000010/v1_201706100114/S2387020617303108/v1_201706100114/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303108?idApp=UINPBA00004N" ]
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