Quantitative myocardial contrast echocardiography during pharmacological stress for diagnosis of coronary artery disease: a systematic review and meta-analysis of diagnostic accuracy studies.
OBJECTIVE
We conducted a meta-analysis to evaluate the accuracy of quantitative stress myocardial contrast echocardiography (MCE) in coronary artery disease (CAD).


RESULTS
Database search was performed through January 2008. We included studies evaluating accuracy of quantitative stress MCE for detection of CAD compared with coronary angiography or single-photon emission computed tomography (SPECT) and measuring reserve parameters of A, beta, and Abeta. Data from studies were verified and supplemented by the authors of each study. Using random effects meta-analysis, we estimated weighted mean difference (WMD), likelihood ratios (LRs), diagnostic odds ratios (DORs), and summary area under curve (AUC), all with 95% confidence interval (CI). Of 1443 studies, 13 including 627 patients (age range, 38-75 years) and comparing MCE with angiography (n = 10), SPECT (n = 1), or both (n = 2) were eligible. WMD (95% CI) were significantly less in CAD group than no-CAD group: 0.12 (0.06-0.18) (P < 0.001), 1.38 (1.28-1.52) (P < 0.001), and 1.47 (1.18-1.76) (P < 0.001) for A, beta, and Abeta reserves, respectively. Pooled LRs for positive test were 1.33 (1.13-1.57), 3.76 (2.43-5.80), and 3.64 (2.87-4.78) and LRs for negative test were 0.68 (0.55-0.83), 0.30 (0.24-0.38), and 0.27 (0.22-0.34) for A, beta, and Abeta reserves, respectively. Pooled DORs were 2.09 (1.42-3.07), 15.11 (7.90-28.91), and 14.73 (9.61-22.57) and AUCs were 0.637 (0.594-0.677), 0.851 (0.828-0.872), and 0.859 (0.842-0.750) for A, beta, and Abeta reserves, respectively.


CONCLUSIONS
Evidence supports the use of quantitative MCE as a non-invasive test for detection of CAD. Standardizing MCE quantification analysis and adherence to reporting standards for diagnostic tests could enhance the quality of evidence in this field.
Abdelmoneim
Sahar S
SS
Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Dhoble
Abhijeet
A
Bernier
Mathieu
M
Erwin
Patricia J
PJ
Korosoglou
Grigorios
G
Senior
Roxy
R
Moir
Stuart
S
Kowatsch
Ingrid
I
Xian-Hong
Shu
S
Muro
Takashi
T
Dawson
Dana
D
Vogel
Rolf
R
Wei
Kevin
K
West
Colin P
CP
Montori
Victor M
VM
Pellikka
Patricia A
PA
Abdel-Kader
Samir S
SS
Mulvagh
Sharon L
SL
D000328:Adult; D000368:Aged; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003326:Coronary Circulation; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D003287:Contrast Media; D019275:Radiopharmaceuticals