Elsevier

American Heart Journal

Volume 154, Issue 3, September 2007, Pages 415-423
American Heart Journal

Curriculum in Cardiology
Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: A meta-analysis of diagnostic performance

https://doi.org/10.1016/j.ahj.2007.04.061Get rights and content

Background

Many studies have been published on the diagnostic performance of noninvasive tests for the assessment of coronary artery disease. The objective of the present study was to compare the published literature on the diagnostic performance of stress echocardiography, stress single-photon-emission computed tomography (SPECT), and electron beam computed tomography (EBCT).

Methods

Meta-analytic studies on the diagnostic performance of imaging tests for coronary artery disease were searched in the Cochrane Library, PubMed, and bibliographies of selected articles. Sensitivities, specificities, and diagnostic odds ratios of the source studies were calculated per modality. Taking into account differences between studies, a random effects summary receiver operating characteristic analysis was performed.

Results

We analyzed the data of 351 patient series, which were reported in 11 meta-analyses. The sensitivity of EBCT was significantly higher than that of stress SPECT, which had a significantly higher sensitivity than stress echocardiography (respectively, 93.1% [95% confidence interval, 90.7-95.6], 88.1 [95% confidence interval, 86.6-89.6], and 79.1% [95% confidence interval, 77.6-80.5]). The specificity of stress echocardiography was significantly higher than that of stress SPECT, which had a significantly higher specificity than EBCT (respectively, 87.1% [95% confidence interval, 85.7-88.5], 73.0% [95% confidence interval, 69.1-76.9], and 54.5% [95% confidence interval, 45.3-63.8]). The diagnostic odds ratios did not differ significantly between the 3 modalities, which resulted in one underlying summary receiver operating characteristic curve.

Conclusions

This study suggests that there are no significant differences in the overall diagnostic performance between stress echocardiography, stress SPECT, and EBCT for the diagnosis of coronary artery disease. However, differences exist in sensitivity and specificity estimates, which may make each modality useful in different settings.

Section snippets

Study selection

A literature search was performed in the Cochrane Library and in PubMed from January 1990 through December 2006 to identify meta-analyses on the diagnostic performance of noninvasive imaging tests for the diagnosis of coronary artery disease. We used the following search terms: (echocardiography OR single-photon-emission computed tomography OR electron beam computed tomography) AND coronary AND specificity, limited to meta-analyses. We also checked the references of the included articles for

Study selection

The search strategy resulted in 120 abstracts, of which 16 meta-analyses were found that reported on coronary artery disease.4, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 Of the 16 meta-analyses, one study was excluded because it was published before 1990.12 One meta-analysis did not report the absolute numbers of true-positive, false-positive, true-negative, and false-negative test results of the source studies.15 The author of this meta-analysis was requested to provide the

Discussion

In this study, we combined data from over 35,000 patients who underwent 9 different noninvasive imaging technologies for coronary artery disease. The analysis showed that the differences in diagnostic performance between the coronary tests were small. We showed that stress SPECT and EBCT are more sensitive tests, whereas stress echocardiography is more specific. The diagnostic odds ratios, however, did not differ significantly between the imaging modalities, indicating equal diagnostic

Acknowledgement

The authors thank C. Kim for providing the absolute numbers of test results from the source studies included in her meta-analyses.

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    Financial support for this study was provided by a Program Grant (904-66-091) from the Netherlands Organization for Scientific Research and by a grant from the American Society of Echocardiography.

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