Abstract 604: Exercise Single Photon Emission Computed Tomography (SPECT) Imaging or Exercise Echocardiography? A Meta-Analysis of Exercise Testing for Diagnosis of High-Risk Coronary Artery Disease
Background Although noninvasive exercise stress tests are widely used, their relative performance in detection of high-risk coronary artery disease (HRCAD) is not clear. The cumulative published literature was reviewed to compare the performance of exercise stress test combined with single photon emission computed tomography (SPECT) imaging or echocardiography (ECHO) in the diagnosis of HRCAD.
Methods Quantitative meta-analysis was performed using data from studies identified by Medline search. Studies were included if they used exercise ECHO or SPECT imaging with Tl 201 or Tc 99m Sestamibi for detection of left main (LM) and triple vessel disease (TVD), and included coronary angiography as the reference test. Data were extracted using perfusion abnormalities (any reversible perfusion deficit) and ancillary (ECG changes, transient ischemic dilatation, abnormal lung uptake, hypotension) parameters for SPECT, and wall motion (any reversible regional wall motion) abnormality and ancillary (ECG changes) parameter for ECHO reported by the authors. Sensitivity and specificity were computed. Summary receiver operating characteristic (SROC) analysis and metaregression were performed.
Results Fifteen studies met inclusion criteria (SPECT-9; ECHO-6). This included 1,887 (SPECT-1,256; ECHO-631) patients. In pooled data weighted by the inverse of variance, exercise ECHO had a higher sensitivity (95% vs. 77%), but similar specificity (37% vs. 41%) to SPECT. The diagnostic odds ratios (9.72 vs. 6.85) on metaregression and SROC analysis (0.84 vs. 0.76) were similar. Comparison of isolated perfusion abnormalities on SPECT to wall motion abnormalities alone on ECHO yielded similar results (Table⇓).
Conclusions In the absence of a direct head to head analysis, this meta-analysis suggests that although the diagnostic performance is similar, exercise echocardiography appears to be the screening modality of choice for HRCAD when exercise is used as the stressor.