Xiu Jiancheng, Cui Kai, Wang Yuegang, Zheng Hua, Chen Gangbin, Feng Qian, Bin Jianping, Wu Juefei, Porter Thomas R
Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
J Am Soc Echocardiogr. 2017 Mar;30(3):270-281. doi: 10.1016/j.echo.2016.11.015. Epub 2016 Dec 31.
Myocardial perfusion (MP) imaging during stress myocardial contrast echocardiography (MCE) improves the detection of coronary artery disease (CAD). However, its prognostic value to predict cardiac events in patients with known or suspected CAD is still undefined.
A search was conducted for single- or multicenter prospective studies that evaluated the prognostic value of stress MCE in patients with known or suspected CAD. A database search was performed through June 2015. Effect sizes of relative risk ratios (RRs) with their corresponding 95% CIs were used to evaluate the association between the occurrence of total cardiac events (cardiac death, nonfatal myocardial infarction, coronary revascularization) and hard cardiac events (cardiac death and nonfatal myocardial infarction) in subjects with normal and abnormal MP measured by MCE. The Cochran Q statistic and the I statistic were used to assess heterogeneity.
A comprehensive literature search of the MEDLINE, Google Scholar, Cochrane, and Embase databases identified 11 studies enrolling a total of 4,045 patients. The overall analysis of RRs revealed that patients with abnormal MP were at higher risk for total cardiac events compared with patients with normal MP (RR, 5.58; 95% CI, 3.64-8.57; P < .001), with low heterogeneity among trials (I = 48.15%, Q = 7.71, P = .103). Similarly, patients with abnormal MP were at higher risk for hard cardiac events compared with patients with normal MP (RR, 4.99; 95% CI, 1.75-14.32; P = .003), with significant heterogeneity among trials (I = 81.48%, Q = 21.59, P < .001).
The results of this meta-analysis suggest that MP assessment using stress MCE is an effective prognostic tool for predicting the occurrence of cardiac events in patients with known or suspected CAD.
负荷心肌对比超声心动图（MCE）期间的心肌灌注（MP）成像可改善冠状动脉疾病（CAD）的检测。然而，其对已知或疑似CAD患者心脏事件的预测价值仍不明确。
检索评估负荷MCE对已知或疑似CAD患者预后价值的单中心或多中心前瞻性研究。通过2015年6月进行数据库检索。使用相对风险比（RRs）及其相应的95%置信区间（CIs）的效应量来评估通过MCE测量的MP正常和异常受试者中总心脏事件（心源性死亡、非致命性心肌梗死、冠状动脉血运重建）和严重心脏事件（心源性死亡和非致命性心肌梗死）发生之间的关联。使用 Cochr an Q统计量和I统计量评估异质性。
对MEDLINE、谷歌学术、Cochrane和Embase数据库进行全面文献检索，确定了11项研究，共纳入4045例患者。RRs的总体分析显示，与MP正常的患者相比，MP异常的患者发生总心脏事件的风险更高（RR，5.58；95%CI，3.64 - 8.57；P <.001），各试验间异质性较低（I = 48.15%，Q = 7.71，P =.103）。同样，与MP正常的患者相比，MP异常的患者发生严重心脏事件的风险更高（RR，4.99；95%CI，1.75 - 14.32；P =.003），各试验间存在显著异质性（I = 81.48%，Q = 21.59，P <.001）。
这项荟萃分析的结果表明，使用负荷MCE进行MP评估是预测已知或疑似CAD患者心脏事件发生的有效预后工具。
