title: Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis.
abstract: BACKGROUND
  Myocardial perfusion (MP) imaging during stress myocardial contrast echocardiography (MCE) improves the detection of coronary artery disease (CAD). However, its prognostic value to predict cardiac events in patients with known or suspected CAD is still undefined.
  
  
  METHODS
  A search was conducted for single- or multicenter prospective studies that evaluated the prognostic value of stress MCE in patients with known or suspected CAD. A database search was performed through June 2015. Effect sizes of relative risk ratios (RRs) with their corresponding 95% CIs were used to evaluate the association between the occurrence of total cardiac events (cardiac death, nonfatal myocardial infarction, coronary revascularization) and hard cardiac events (cardiac death and nonfatal myocardial infarction) in subjects with normal and abnormal MP measured by MCE. The Cochran Q statistic and the I2statistic were used to assess heterogeneity.
  
  
  RESULTS
  A comprehensive literature search of the MEDLINE, Google Scholar, Cochrane, and Embase databases identified 11 studies enrolling a total of 4,045 patients. The overall analysis of RRs revealed that patients with abnormal MP were at higher risk for total cardiac events compared with patients with normal MP (RR, 5.58; 95% CI, 3.64-8.57; P < .001), with low heterogeneity among trials (I2= 48.15%, Q = 7.71, P = .103). Similarly, patients with abnormal MP were at higher risk for hard cardiac events compared with patients with normal MP (RR, 4.99; 95% CI, 1.75-14.32; P = .003), with significant heterogeneity among trials (I2= 81.48%, Q = 21.59, P < .001).
  
  
  CONCLUSIONS
  The results of this meta-analysis suggest that MP assessment using stress MCE is an effective prognostic tool for predicting the occurrence of cardiac events in patients with known or suspected CAD.
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Xiu
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Cui
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
authors.forename: Yuegang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
authors.forename: Gangbin
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Feng
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Bin
authors.affiliation: Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China. Electronic address: jaffiwu@hotmail.com.
authors.forename: Juefei
authors.initials: J
authors.lastname: Wu
authors.affiliation: Division of Cardiology Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D025401:Echocardiography, Stress / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality*; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis
keywords: Coronary artery disease; Myocardial contrast echocardiography; Myocardial perfusion; Prognosis; Stress echocardiography