Myocardial perfusion scintigraphy and echocardiography for detecting coronary artery disease in hypertensive patients: A meta-analysis

Paola Gargiulo, Mario Petretta, Dario Bruzzese, Alberto Cuocolo, Maria Prastaro, Carmen D'Amore, Enrico Vassallo, Gianluigi Savarese, Caterina Marciano, Stefania Paolillo, Pasquale Perrone Filardi

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: This meta-analysis summarized the accuracy of stress myocardial perfusion scintigraphy (MPS) and stress echocardiography for the diagnosis of coronary artery disease (CAD) in patients with arterial hypertension. Methods: We searched for studies in which stress MPS or stress echocardiography were performed to detect CAD in hypertensive patients, with coronary angiography used as the reference test, published from January 1980 to December 2010. Studies performed in patients with known CAD, acute coronary syndrome and previous revascularization procedures were excluded. Results: Of 1,263 studies, 13 met the inclusion criteria. Pooled summary estimates showed that stress MPS had a sensitivity of 0.90 [95% confidence interval (CI) 0.82-0.95] and a specificity of 0.63 (95% CI 0.53-0.72). For stress MPS, the area under the curve (AUC) at the summary receiver-operating characteristic (SROC) graph was 0.83 (95% CI 0.80-0.86). At meta-regression analysis, the presence of positive stress electrocardiography as inclusion criterion was the only significant effect modifier (p <0.01). Pooled summary estimates showed that stress echocardiography had a sensitivity of 0.77 (95% CI 0.69-0.83) and a specificity of 0.89 (95% CI 0.83-0.93). For stress echocardiography, the AUC at SROC was 0.91 (95% CI 0.88-0.93). At the meta-regression analysis no significant effect modifier was detected. Conclusion: MPS has high sensitivity for detecting CAD in hypertensive patients, with specificity comparable to that reported in the general population, whereas stress echocardiography shows higher specificity but substantially reduced sensitivity compared to MPS.

Original languageEnglish
Pages (from-to)2040-2049
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume38
Issue number11
DOIs
Publication statusPublished - Nov 2011

Keywords

  • Arterial hypertension
  • Coronary artery disease
  • Stress echocardiography
  • Stress myocardial perfusion scintigraphy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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