title: Myocardial perfusion scintigraphy and echocardiography for detecting coronary artery disease in hypertensive patients: a meta-analysis.
abstract: OBJECTIVE
  This meta-analysis summarized the accuracy of stress myocardial perfusion scintigraphy (MPS) and stress echocardiography for the diagnosis of coronary artery disease (CAD) in patients with arterial hypertension.
  
  
  METHODS
  We searched for studies in which stress MPS or stress echocardiography were performed to detect CAD in hypertensive patients, with coronary angiography used as the reference test, published from January 1980 to December 2010. Studies performed in patients with known CAD, acute coronary syndrome and previous revascularization procedures were excluded.
  
  
  RESULTS
  Of 1,263 studies, 13 met the inclusion criteria. Pooled summary estimates showed that stress MPS had a sensitivity of 0.90 [95% confidence interval (CI) 0.82-0.95] and a specificity of 0.63 (95% CI 0.53-0.72). For stress MPS, the area under the curve (AUC) at the summary receiver-operating characteristic (SROC) graph was 0.83 (95% CI 0.80-0.86). At meta-regression analysis, the presence of positive stress electrocardiography as inclusion criterion was the only significant effect modifier (p < 0.01). Pooled summary estimates showed that stress echocardiography had a sensitivity of 0.77 (95% CI 0.69-0.83) and a specificity of 0.89 (95% CI 0.83-0.93). For stress echocardiography, the AUC at SROC was 0.91 (95% CI 0.88-0.93). At the meta-regression analysis no significant effect modifier was detected.
  
  
  CONCLUSIONS
  MPS has high sensitivity for detecting CAD in hypertensive patients, with specificity comparable to that reported in the general population, whereas stress echocardiography shows higher specificity but substantially reduced sensitivity compared to MPS.
authors.affiliation: Department of Internal Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gargiulo
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.forename: Dario
authors.initials: D
authors.lastname: Bruzzese
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
authors.forename: Maria
authors.initials: M
authors.lastname: Prastaro
authors.forename: Carmen
authors.initials: C
authors.lastname: D'Amore
authors.forename: Enrico
authors.initials: E
authors.lastname: Vassallo
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.forename: Caterina
authors.initials: C
authors.lastname: Marciano
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolillo
authors.forename: Pasquale Perrone
authors.initials: PP
authors.lastname: Filardi
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D012372:ROC Curve; D013312:Stress, Physiological