Myocardial perfusion scintigraphy and echocardiography for detecting coronary artery disease in hypertensive patients: a meta-analysis

  • Paola Gargiulo
  • Mario Petretta
  • Dario Bruzzese
  • Alberto Cuocolo
  • Maria Prastaro
  • Carmen D’Amore
  • Enrico Vassallo
  • Gianluigi Savarese
  • Caterina Marciano
  • Stefania Paolillo
  • Pasquale Perrone Filardi
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

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.

Conclusion

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.

Keywords

Arterial hypertension Stress myocardial perfusion scintigraphy Stress echocardiography Coronary artery disease 
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Notes

Conflicts of interest

None.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Paola Gargiulo
    • 1
  • Mario Petretta
    • 1
  • Dario Bruzzese
    • 2
  • Alberto Cuocolo
    • 3
  • Maria Prastaro
    • 1
  • Carmen D’Amore
    • 1
  • Enrico Vassallo
    • 1
  • Gianluigi Savarese
    • 1
  • Caterina Marciano
    • 1
  • Stefania Paolillo
    • 1
  • Pasquale Perrone Filardi
    • 1
  1. 1.Department of Internal Medicine, Cardiovascular and Immunological SciencesUniversity Federico IINaplesItaly
  2. 2.Department of Preventive Medical SciencesUniversity Federico IINaplesItaly
  3. 3.Department of Biomorphological and Functional SciencesUniversity Federico II and SDN Foundation, Institute of Diagnostic and Nuclear DevelopmentNaplesItaly

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