Quantitative myocardial contrast echocardiography during pharmacological stress for diagnosis of coronary artery disease: A systematic review and meta-analysis of diagnostic accuracy studies

Sahar S. Abdelmoneim, Abhijeet Dhoble, Mathieu Bernier, Patricia J. Erwin, Grigorios Korosoglou, Roxy Senior, Stuart Moir, Ingrid Kowatsch, Shu Xian-Hong, Takashi Muro, Dana Dawson, Rolf Vogel, Kevin Wei, Colin P. West, Victor M. Montori, Patricia A. Pellikka, Samir S. Abdel-Kader, Sharon L. Mulvagh

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    36 Scopus citations

    Abstract

    Aims: We conducted a meta-analysis to evaluate the accuracy of quantitative stress myocardial contrast echocardiography (MCE) in coronary artery disease (CAD). Methods and results: Database search was performed through January 2008. We included studies evaluating accuracy of quantitative stress MCE for detection of CAD compared with coronary angiography or single-photon emission computed tomography (SPECT) and measuring reserve parameters of A, β, and Aβ. Data from studies were verified and supplemented by the authors of each study. Using random effects meta-analysis, we estimated weighted mean difference (WMD), likelihood ratios (LRs), diagnostic odds ratios (DORs), and summary area under curve (AUC), all with 95 confidence interval (CI). Of 1443 studies, 13 including 627 patients (age range, 38-75 years) and comparing MCE with angiography (n = 10), SPECT (n = 1), or both (n = 2) were eligible. WMD (95 CI) were significantly less in CAD group than no-CAD group: 0.12 (0.06-0.18) (P < 0.001), 1.38 (1.28-1.52) (P < 0.001), and 1.47 (1.18-1.76) (P < 0.001) for A, β, and Aβ reserves, respectively. Pooled LRs for positive test were 1.33 (1.13-1.57), 3.76 (2.43-5.80), and 3.64 (2.87-4.78) and LRs for negative test were 0.68 (0.55-0.83), 0.30 (0.24-0.38), and 0.27 (0.22-0.34) for A, β, and Aβ reserves, respectively. Pooled DORs were 2.09 (1.42-3.07), 15.11 (7.90-28.91), and 14.73 (9.61-22.57) and AUCs were 0.637 (0.594-0.677), 0.851 (0.828-0.872), and 0.859 (0.842-0.750) for A, β, and Aβ reserves, respectively. Conclusion Evidence supports the use of quantitative MCE as a non-invasive test for detection of CAD. Standardizing MCE quantification analysis and adherence to reporting standards for diagnostic tests could enhance the quality of evidence in this field.

    Original languageEnglish (US)
    Pages (from-to)813-825
    Number of pages13
    JournalEuropean Journal of Echocardiography
    Volume10
    Issue number7
    DOIs
    StatePublished - Oct 2009

    Keywords

    • Coronary artery disease
    • Myocardial perfusion
    • Quantitative contrast
    • Stress echocardiography

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

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    Abdelmoneim, S. S., Dhoble, A., Bernier, M., Erwin, P. J., Korosoglou, G., Senior, R., Moir, S., Kowatsch, I., Xian-Hong, S., Muro, T., Dawson, D., Vogel, R., Wei, K., West, C. P., Montori, V. M., Pellikka, P. A., Abdel-Kader, S. S., & Mulvagh, S. L. (2009). Quantitative myocardial contrast echocardiography during pharmacological stress for diagnosis of coronary artery disease: A systematic review and meta-analysis of diagnostic accuracy studies. European Journal of Echocardiography, 10(7), 813-825. https://doi.org/10.1093/ejechocard/jep084