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Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance
K E Fleischmann1, M G Hunink, K M Kuntz
1Cardiology Division, University of California, Medical Center, San Francisco 94143-0214, USA. Fleischm@cardio.ucsf.edu
JAMA
|September 18, 1998
Summary
Exercise echocardiography (ECHO) and exercise single-photon emission computed tomography (SPECT) show similar sensitivity for detecting coronary artery disease. However, ECHO demonstrates superior specificity and overall diagnostic performance.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Cardiac imaging offers multiple options for diagnosing coronary artery disease (CAD).
- Direct comparisons between imaging modalities are limited.
- Evaluating diagnostic performance is crucial for clinical decision-making.
Purpose of the Study:
- To compare the diagnostic performance of exercise echocardiography (ECHO) and exercise single-photon emission computed tomography (SPECT) for CAD.
- To review contemporary literature on exercise ECHO and SPECT in CAD diagnosis.
Main Methods:
- Systematic literature review of studies published between 1990 and 1997.
- Inclusion criteria: exercise ECHO or SPECT for CAD detection, coronary angiography as reference, and available diagnostic data.
- Exclusion criteria: studies in post-MI, post-PTCA, post-CABG, or unstable CAD patients.
Main Results:
- Forty-four articles were included in the analysis.
- Pooled sensitivity: ECHO 85%, SPECT 87%. Pooled specificity: ECHO 77%, SPECT 64%.
- Exercise ECHO showed significantly better discriminatory power than SPECT, with greater incremental improvement over exercise testing alone.
Conclusions:
- Exercise ECHO and SPECT have comparable sensitivity for CAD detection.
- Exercise ECHO exhibits superior specificity and overall discriminatory capability.
- Exercise ECHO is a highly effective imaging modality for diagnosing coronary artery disease in contemporary practice.