A perspective on standardizing the predictive power of noninvasive cardiovascular tests by likelihood ratio computation: 2. Clinical applications

Abstract

Likelihood ratio measures may be used as a standard for expressing the predictive power of noninvasive cardiovascular tests, calculated from sensitivity and specificity measures or as ratios of the predictive value odds to pretest odds for positive and negative test results. The positive likelihood ratio, (+)LR, expresses the power of a positive test result to augment an estimate of disease probability independent of the pretest prevalence of disease in a given population; the negative likelihood ratio, (-)LR, expresses the power of a negative test result to augment an estimate of the probability of no disease independent of the pretest prevalence of no disease in the same population. The likelihood ratio principle is applicable to the evaluation of the predictive power of single or combined test results reported for either dichotomous or continuous end points. This part of the perspective exemplifies application of the likelihood ratio principle in a wide variety of testing conditions for coronary artery disease followed by a discussion of the limitations of likelihood ratio computation in test power evaluation. Likelihood ratios provide a more concise and unambiguous standard for calibrating the predictive power of single and combined noninvasive cardiovascular test results than are provided by measures of sensitivity, specificity, and predictive value.