Internal Medicine Division of Cardiology, Wayne State University, Harper University Hospital, 3990 John R., Detroit, MI 48201, USA.
Heart. 2010 Jun;96(12):956-66. doi: 10.1136/hrt.2009.182295.
Compare the diagnostic performance of stress echocardiography (SE) and myocardial perfusion imaging (MPI) for the diagnosis of left main disease (LM) and triple vessel disease (TVD).
Limited comparative data on MPI and SE for the detection of LM and TVD (high-risk coronary artery disease) exist in the literature.
Quantitative meta-analysis was performed using studies identified by systematic electronic literature search. Articles were included if they reported data on exercise, dobutamine SE or exercise, adenosine, dipyridamole, thallium201, technetium 99m sestamibi MPI and used coronary angiography as the reference test. Summary receiver-operating characteristic (SROC) curves were constructed for each imaging modality. Additionally, pooled sensitivity, specificity and likelihood ratios were calculated per modality. Meta-regression was performed to adjust for patient and study characteristics.
Thirty-two studies met inclusion criteria; 23 (MPI-15; SE-14; Common studies-6) provided sufficient data for analysis. In a SROC model comparing the two imaging modalities, SE was associated with higher area under curve (0.82 (0.03) vs 0.73 (0.02), p=0.01) and index Q* value (0.75 (0.02) vs 0.67 (0.02), p=0.01). Using pooled summary point estimates, SE had higher pooled sensitivity (94% vs 75%, p<0.001) and lower negative likelihood ratio (0.21 vs 0.47, p<0.001) compared to MPI. No evidence of a difference in the pooled specificity (40% vs 48%, p=0.16) and positive likelihood ratio (1.52 vs 1.58, p=0.36) was seen between the two stress modalities. Pooled diagnostic OR on meta-regression (9.78 vs 4.06, p=0.02) remained significantly higher for SE compared to MPI for identification of LM and TVD even after adjustment for study characteristics.
Since LM alone or in combination with TVD are categorised as representing potentially life-threatening variants of CAD, a screening test with high sensitivity, low negative likelihood ratio or higher discriminatory capacity would be desirable for risk stratification. In the absence of a direct head-to-head comparison of the diagnostic accuracies of SE and MPI, our findings indicate that SE appears to be the preferred screening modality for high-risk coronary artery disease.
比较应激超声心动图（SE）和心肌灌注成像（MPI）诊断左主干病变（LM）和三血管病变（TVD）的诊断性能。
文献中关于 MPI 和 SE 检测 LM 和 TVD（高危冠状动脉疾病）的比较数据有限。
通过系统的电子文献搜索，对确定的研究进行定量荟萃分析。如果文章报告了关于运动、多巴酚丁胺 SE 或运动、腺苷、双嘧达莫、铊 201、锝 99m sestamibi MPI 的数据，并将冠状动脉造影作为参考试验，则将其纳入研究。为每种成像方式构建汇总受试者工作特征（SROC）曲线。此外，还计算了每种方式的汇总敏感性、特异性和似然比。进行荟萃回归分析以调整患者和研究特征。
32 项研究符合纳入标准；23 项（MPI-15；SE-14；共同研究-6）提供了足够的数据进行分析。在比较两种成像方式的 SROC 模型中，SE 的曲线下面积（0.82（0.03）比 0.73（0.02），p=0.01）和指数 Q* 值（0.75（0.02）比 0.67（0.02），p=0.01）更高。使用汇总汇总点估计值，SE 的汇总敏感性更高（94%比 75%，p<0.001），阴性似然比更低（0.21 比 0.47，p<0.001）。两种应激方式的汇总特异性（40%比 48%，p=0.16）和阳性似然比（1.52 比 1.58，p=0.36）无差异。荟萃回归分析的汇总诊断优势比（9.78 比 4.06，p=0.02）仍然表明，与 MPI 相比，SE 用于识别 LM 和 TVD 的优势更高。即使在调整研究特征后，这一结果仍然成立。
由于 LM 单独或与 TVD 合并存在危及生命的高危变体，因此需要一种具有高敏感性、低阴性似然比或更高鉴别能力的筛查试验进行风险分层。由于没有 SE 和 MPI 的诊断准确性的直接头对头比较，我们的研究结果表明，SE 似乎是高危冠状动脉疾病的首选筛查方法。
