title: The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis.
abstract: OBJECTIVE
  The purpose of this work was to determine the prognostic value of normal exercise myocardial perfusion imaging (MPI) tests and exercise echocardiography tests, and to determine the prognostic value of these imaging modalities in women and men.
  
  
  BACKGROUND
  Exercise MPI and exercise echocardiography provide prognostic information that is useful in the risk stratification of patients with suspected coronary artery disease (CAD).
  
  
  METHODS
  We searched the PubMed, Cochrane, and DARE databases between January 1990 and May 2005, and reviewed bibliographies of articles obtained. We included prospective cohort studies of subjects who underwent exercise MPI or exercise echocardiography for known or suspected CAD, and provided data on primary outcomes of myocardial infarction (MI) and cardiac death with at least 3 months of follow-up. Secondary outcomes (unstable angina, revascularization procedures) were abstracted if provided. Studies performed exclusively in patients with CAD were excluded.
  
  
  RESULTS
  The negative predictive value (NPV) for MI and cardiac death was 98.8% (95% confidence interval [CI] 98.5 to 99.0) over 36 months of follow-up for MPI, and 98.4% (95% CI 97.9 to 98.9) over 33 months for echocardiography. The corresponding annualized event rates were 0.45% per year for MPI and 0.54% per year for echocardiography. In subgroup analyses, annualized event rates were <1% for each MPI isotope, and were similar for women and men. For secondary events, MPI and echocardiography had annualized event rates of 1.25% and 0.95%, respectively.
  
  
  CONCLUSIONS
  Both exercise MPI and exercise echocardiography have high NPVs for primary and secondary cardiac events. The prognostic utility of both modalities is similar for both men and women.
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York, USA.
authors.forename: Louise D
authors.initials: LD
authors.lastname: Metz
authors.forename: Mary
authors.initials: M
authors.lastname: Beattie
authors.forename: Robert
authors.initials: R
authors.lastname: Hom
authors.forename: Rita F
authors.initials: RF
authors.lastname: Redberg
authors.forename: Deborah
authors.initials: D
authors.lastname: Grady
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Fleischmann
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012737:Sex Factors; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon