Enhanced diagnostic utility achieved by myocardial blood analysis: A meta-analysis of noninvasive cardiac imaging in the detection of functional coronary artery disease.

AIM

The aim of this study is to determine the diagnostic utility of 6 cardiac imaging modalities using fractional flow reserve (FFR) as the reference standard.

METHODS

Studies reporting diagnostic performance of computed tomographic perfusion imaging (CTP), fractional flow reserve derived from computed tomography (FFRCT), cardiac magnetic resonance (CMR), positron emission tomography (PET), single-photon emission computed tomography (SPECT) and dobutamine stress echocardiography (DSE) for diagnosis of ischemia-causing lesions were included.

RESULTS

On vessel-based and patient-based analyses, CMR, PET, CTP and FFRCT exhibited comparable sensitivity (per-vessel: 87% vs. 86% vs. 89% vs. 86%; per-patient: 88% vs. 90% vs. 88% vs. 90%, P>0.05) and specificity (per-vessel: 89% vs. 88% vs. 89% vs. 83%; per-patient: 84% vs. 84% vs. 87% vs. 75%, P>0.05); whereas SPECT yielded significantly lower sensitivity (per-vessel: 72%; per-patient: 78%, P<0.05) and specificity (per-vessel: 79%; per-patient: 79%, P<0.05) and DES yielded significantly lower sensitivity (per-vessel: 62%, per-patient: 69%, P<0.05). On the other hand, within the same imaging modality, myocardial blood flow (MBF) derived by CTP had a higher sensitivity (90% vs. 80%, P=0.048) but lower specificity (77% vs. 93%, P=0.02) than that of perfusion defect (PD). Moreover, MBF derived by CMR had a lower specificity than that of PD (60% vs. 93%, P=0.02), while coronary flow reserve (CRF) derived by PET had a lower specificity than that of MBF (81% vs. 89%, P=0.005).

CONCLUSION

CMR, PET, CTP and FFRCT expressed similar and high accuracy in detecting functional CAD, whereas different analysis methods for each imaging modality may vary their diagnostic utility.