Elkaryoni Ahmed, Abu-Sheasha Ghada, Altibi Ahmed M, Hassan Adil, Ellakany Karim, Nanda Navin C
Division of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri.
Division of Biomedical Statistics and Medical Informatics, Medical Research Institute, Alexandria University, Alexandria, Egypt.
Echocardiography. 2019 Mar;36(3):528-536. doi: 10.1111/echo.14268. Epub 2019 Feb 6.
Dobutamine stress echocardiography (DSE) is a well-established imaging modality used to screen patients with mild-to-moderate risk for coronary artery disease. In heart transplantation recipients, cardiac allograft vasculopathy (CAV) is a common and lethal complication. The use of DSE to detect CAV showed promising results initially, but later studies showed limitation in its use to detect CAV. It is unclear if this cohort of patients derives benefit from DSE.
We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Scopus from inception through March 2018 for studies examining the accuracy of DSE in correlation to coronary angiography (CA) or intravascular ultrasound (IVUS) to detect CAV. Original studies comparing the ability of DSE to detect CAV in comparison with CA or IVUS were included. Relevant data were extracted and hierarchical summary receiver operating characteristic analysis was conducted to test the overall diagnostic accuracy of DSE for patients with CAV.
Eleven studies (749 participants) met the inclusion criteria. The sensitivity of DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%. Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%-82.3%) and specificity 85.7% (95% CI, 73.8%-92.7%). DSE had an overall diagnostic odds ratio (OR) of 9.1 (95% CI, 4.6-17.8), positive likelihood ratio (LR+) of 4.1 (95% CI, 2.8-6.1), negative likelihood ratio (LR-) of 0.47 (95% CI: 0.23-0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72-0.75). Heterogeneity among studies was not statistically significant (τ = 0.32, Cochran's Q = 9.5, P = 0.483).
Dobutamine stress echocardiography has a limited sensitivity to detect early CAV but its specificity is much higher. There remains a need for an alternative noninvasive modality which will have both high sensitivity and high specificity for detecting CAV.
多巴酚丁胺负荷超声心动图（DSE）是一种成熟的影像学检查方法，用于筛查有轻度至中度冠心病风险的患者。在心脏移植受者中，心脏移植血管病变（CAV）是一种常见且致命的并发症。最初使用DSE检测CAV显示出有前景的结果，但后来的研究显示其在检测CAV方面存在局限性。目前尚不清楚这组患者是否能从DSE中获益。
我们检索了从创刊至2018年3月的PubMed、Cochrane对照试验中心注册库（CENTRAL）、Embase和Scopus，以查找研究DSE与冠状动脉造影（CA）或血管内超声（IVUS）相关检测CAV准确性的研究。纳入了比较DSE与CA或IVUS检测CAV能力的原始研究。提取相关数据并进行分层汇总接受者操作特征分析，以测试DSE对CAV患者的总体诊断准确性。
11项研究（749名参与者）符合纳入标准。DSE的敏感性从1.7%到93.8%不等，特异性从54.8%到98.8%不等。合并敏感性为60.2%（95%置信区间（CI），33.0%-82.3%），特异性为85.7%（95%CI，73.8%-92.7%）。DSE的总体诊断比值比（OR）为9.1（95%CI，4.6-17.8），阳性似然比（LR+）为4.1（95%CI，2.8-6.1），阴性似然比（LR-）为0.47（95%CI：0.23-0.73），曲线下面积（AUC）为0.73（95%CI，0.72-0.75）。研究间的异质性无统计学意义（τ = 0.32，Cochran's Q = 9.5，P = 0.483）。
多巴酚丁胺负荷超声心动图检测早期CAV的敏感性有限，但其特异性要高得多。仍然需要一种对检测CAV具有高敏感性和高特异性的替代性非侵入性检查方法。
