Gender differences in the diagnostic accuracy of SPECT myocardial perfusion imaging: A bivariate meta-analysis
- 402 Downloads
It remains controversial whether the diagnostic accuracy of single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is different in men as compared to women. We performed a meta-analysis to investigate gender differences of SPECT MPI for the diagnosis of CAD (≥50% stenosis).
Two investigators independently performed a systematic review of the MEDLINE and EMBASE databases from inception through January 2012 for English-language studies determining the diagnostic accuracy of SPECT MPI. We included prospective studies that compared SPECT MPI with conventional coronary angiography which provided sufficient data to calculate gender-specific true and false positives and negatives. Data from studies evaluating <20 patients of one gender were excluded. Bivariate meta-analysis was used to create summary receiver operating curves.
Twenty-six studies met inclusion criteria, representing 1,148 women and 1,142 men. Bivariate meta-analysis yielded a mean sensitivity and specificity of 84.2% (95% confidence interval [CI] 78.7%-88.6%) and 78.7% (CI 70.0%-85.3%) for SPECT MPI in women and 89.1% (CI 84.0%-92.7%) and 71.2% (CI 60.8%-79.8%) for SPECT MPI in men. There was no significant difference in the sensitivity (P = .15) or specificity (P = .23) between male and female subjects.
In a bivariate meta-analysis of the available literature, the diagnostic accuracy of SPECT MPI is similar for both men and women.
KeywordsMyocardial perfusion imaging: SPECT diagnostic and prognostic application SPECT
Dr Heller serves on the Scientific Advisory Board of Lantheus Medical Imaging. The remaining authors have no disclosures relevant to this project.
- 1.Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003;108:1404-18.PubMedCrossRefGoogle Scholar
- 3.Shaw LJ, Bairey Merz CN, Pepine CJ, Reis SE, Bittner V, Kelsey SF, et al. Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol 2006;47:S4-20.PubMedCrossRefGoogle Scholar
- 9.Macaskill P, Gatsonis C, Deeks J, Harbord R, Takwoingi Y. Analysing and presenting results. In: Deeks J, Bossuyt PM, Gatsonis C, editors. Cochrane handbook for systematic reviews of diagnostic test accuracy. London: The Cochrane Collaboration; 2010.Google Scholar
- 13.Elhendy A, van Domburg RT, Bax JJ, Nierop PR, Geleijnse ML, Ibrahim MM, et al. Noninvasive diagnosis of coronary artery stenosis in women with limited exercise capacity: Comparison of dobutamine stress echocardiography and 99mTc sestamibi single-photon emission CT. Chest 1998;114:1097-104.PubMedCrossRefGoogle Scholar
- 14.Ho YL, Wu CC, Huang PJ, Lin LC, Chieng PU, Chen WJ, et al. Assessment of coronary artery disease in women by dobutamine stress echocardiography: Comparison with stress thallium-201 single-photon emission computed tomography and exercise electrocardiography. Am Heart J 1998;135:655-62.PubMedCrossRefGoogle Scholar
- 15.Lu C, Lu F, Fragasso G, Dabrowski P, Di Bello V, Chierchia SL, et al. Comparison of exercise electrocardiography, technetium-99m sestamibi single photon emission computed tomography, and dobutamine and dipyridamole echocardiography for detection of coronary artery disease in hypertensive women. Am J Cardiol 2010;105:1254-60.PubMedCrossRefGoogle Scholar
- 16.Mieres JH, Makaryus AN, Cacciabaudo JM, Donaldson D, Green SJ, Heller GV, et al. Value of electrocardiographically gated single-photon emission computed tomographic myocardial perfusion scintigraphy in a cohort of symptomatic postmenopausal women. Am J Cardiol 2007;99:1096-9.PubMedCrossRefGoogle Scholar
- 21.Smanio PE, Carvalho AC, Tebexreni AS, Thom A, Rodrigues F, Meneghelo R, et al. Coronary artery disease in asymptomatic type-2 diabetic women. A comparative study between exercise test, cardiopulmonary exercise test, and dipyridamole myocardial perfusion scintigraphy in the identification of ischemia. Arq Bras Cardiol 2007;89:263-9, 90-7.Google Scholar
- 32.Maddahi J, Van Train K, Prigent F, Garcia EV, Friedman J, Ostrzega E, et al. Quantitative single photon emission computed thallium-201 tomography for detection and localization of coronary artery disease: Optimization and prospective validation of a new technique. J Am Coll Cardiol 1989;14:1689-99.PubMedCrossRefGoogle Scholar
- 33.Rosenkranz S, Voth E, Larosee K, Baer FM, Kettering K, Smolarz K, et al. Identification of hemodynamically significant restenosis after percutaneous transluminal coronary angioplasty in acute myocardial infarction by transesophageal dobutamine stress echocardiography and comparison with myocardial single photon emission computed tomography. J Interv Cardiol 2001;14:271-82.PubMedCrossRefGoogle Scholar
- 34.Sciammarella MG, Fragasso G, Gerundini P, Maffioli L, Cappelletti A, Margonato A, et al. 99Tcm-MIBI single photon emission tomography (SPET) for detecting myocardial ischaemia and necrosis in patients with significant coronary artery disease. Nucl Med Commun 1992;13:871-8.PubMedCrossRefGoogle Scholar
- 35.Zafar Ul I, Waris J, Kango ZA. Use of exercise tolerance test and thallium stress test in the diagnosis of ischemic heart disease in soldiers. J Coll Phys Surg Pak 2009;19:406-9.Google Scholar
- 36.Mieres JH, Shaw LJ, Arai A, Budoff MJ, Flamm SD, Hundley WG, et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 2005;111:682-96.PubMedCrossRefGoogle Scholar
- 37.Mieres JH, Shaw LJ, Hendel RC, Miller DD, Bonow RO, Berman DS, et al. American Society of Nuclear Cardiology consensus statement: Task force on women and coronary artery disease—the role of myocardial perfusion imaging in the clinical evaluation of coronary artery disease in women [correction]. J Nucl Cardiol 2003;10:95-101.PubMedCrossRefGoogle Scholar
- 39.Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: A bivariate meta-analysis. Circul Cardiovasc Imaging 2012 (Provisionally accepted August 9, 2012).Google Scholar
- 41.Grady D, Chaput L, Kristof M. Diagnosis and treatment of coronary heart disease in women: Systematic reviews of evidence on selected topics. Evid Rep Technol Assess (Summ) 2003;81:1-4.Google Scholar