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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis
Jiancheng Xiu1, Kai Cui1, Yuegang Wang1
1Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
Insights
Myocardial perfusion (MP) imaging during stress myocardial contrast echocardiography (MCE) effectively predicts cardiac events in patients with coronary artery disease (CAD). Abnormal MP significantly increases the risk of both total and hard cardiac events, establishing MCE as a valuable prognostic tool.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Coronary artery disease (CAD) diagnosis often relies on detecting myocardial perfusion (MP) abnormalities.
- Stress myocardial contrast echocardiography (MCE) is utilized for MP imaging, but its prognostic capability in CAD patients requires further definition.
Purpose of the Study:
- To evaluate the prognostic value of stress MCE in predicting cardiac events in patients with known or suspected CAD.
- To synthesize evidence from prospective studies on the association between MP abnormalities and cardiac event occurrence.
Main Methods:
- A systematic literature search was conducted across multiple databases (MEDLINE, Google Scholar, Cochrane, Embase) up to June 2015.
- Prospective studies evaluating stress MCE for prognosis in CAD patients were included.
- Meta-analysis of relative risk ratios (RRs) was performed to assess the association between abnormal MP and cardiac events (total and hard).
Main Results:
- Eleven studies comprising 4,045 patients were analyzed.
- Abnormal MP on stress MCE was associated with a significantly higher risk of total cardiac events (RR, 5.58; 95% CI, 3.64-8.57) and hard cardiac events (RR, 4.99; 95% CI, 1.75-14.32).
- Low heterogeneity was observed for total cardiac events, while significant heterogeneity was noted for hard cardiac events.
Conclusions:
- Myocardial perfusion assessment using stress MCE is a valuable prognostic tool for patients with known or suspected CAD.
- Abnormal MP identified by stress MCE indicates an elevated risk for future cardiac events.
Background:
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.
Methods:
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 I2 statistic were used to assess heterogeneity.
Results:
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 (I2 = 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 (I2 = 81.48%, Q = 21.59, P < .001).
Conclusions:
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.
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