European Journal of Echocardiography Advance Access published online on June 23, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep084
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Quantitative myocardial contrast echocardiography during pharmacological stress for diagnosis of coronary artery disease: a systematic review and meta-analysis of diagnostic accuracy studies
1 Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
2 Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
3 Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
4 Division of Endocrinology and Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN, USA
5 Department of Cardiology, University of Heidelberg, Heidelberg, Germany
6 Department of Cardiology, Northwick Park Hospital, Harrow, UK
7 Department of Cardiovascular Medicine, University of Queensland, Brisbane, Australia
8 The Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
9 Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
10 Department of Internal Medicine and Cardiology, Osaka City University Medical School, Osaka, Japan
11 Department of Cardiology, Edinburgh Royal Infirmary, Edinburgh, UK
12 Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
13 Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, OR, USA
14 Department of Cardiovascular Medicine, Assiut University, Assiut, Egypt
Received 23 December 2009; accepted after revision 23 May 2009.
* Corresponding author. Tel: +1 507 284 8612. E-mail address: smulvagh{at}mayo.edu
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Abstract |
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Aims: We conducted a meta-analysis to evaluate the accuracy of quantitative stress myocardial contrast echocardiography (MCE) in coronary artery disease (CAD).
Methods and results: Database search was performed through January 2008. We included studies evaluating accuracy of quantitative stress MCE for detection of CAD compared with coronary angiography or single-photon emission computed tomography (SPECT) and measuring reserve parameters of A, β, and Aβ. Data from studies were verified and supplemented by the authors of each study. Using random effects meta-analysis, we estimated weighted mean difference (WMD), likelihood ratios (LRs), diagnostic odds ratios (DORs), and summary area under curve (AUC), all with 95% confidence interval (CI). Of 1443 studies, 13 including 627 patients (age range, 38–75 years) and comparing MCE with angiography (n = 10), SPECT (n = 1), or both (n = 2) were eligible. WMD (95% CI) were significantly less in CAD group than no-CAD group: 0.12 (0.06–0.18) (P < 0.001), 1.38 (1.28–1.52) (P < 0.001), and 1.47 (1.18–1.76) (P < 0.001) for A, β, and Aβ reserves, respectively. Pooled LRs for positive test were 1.33 (1.13–1.57), 3.76 (2.43–5.80), and 3.64 (2.87–4.78) and LRs for negative test were 0.68 (0.55–0.83), 0.30 (0.24–0.38), and 0.27 (0.22–0.34) for A, β, and Aβ reserves, respectively. Pooled DORs were 2.09 (1.42–3.07), 15.11 (7.90–28.91), and 14.73 (9.61–22.57) and AUCs were 0.637 (0.594–0.677), 0.851 (0.828–0.872), and 0.859 (0.842–0.750) for A, β, and Aβ reserves, respectively.
Conclusion: Evidence supports the use of quantitative MCE as a non-invasive test for detection of CAD. Standardizing MCE quantification analysis and adherence to reporting standards for diagnostic tests could enhance the quality of evidence in this field.
Keywords: Coronary artery disease; Myocardial perfusion; Quantitative contrast; Stress echocardiography