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A meta-analytic comparison of echocardiographic stressors

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Abstract

Background: The relative performance of alternative stressors for stress echocardiography for the diagnosis of coronary artery disease (CAD) is not well established. Methods: All studies published between 1981 to December 2001 who met inclusion criteria were included in this analysis. We performed a summary receiver operator characteristic (SROC) analysis and calculated weighted mean of the likelihood ratio and sensitivity/specificity. A covariate analysis using meta-regression methods was also performed. Results: Forty-four studies presented data on Exercise, 11 on Adenosine, 80 on Dobutamine, 40 on Dipyridamole, 16 on transatrial pacing transesophageal echocardiography (Tap-TEE), and 7 on transatrial pacing transthorasic echocardiography (Tap-TTE). SROC analysis showed that the following order of most discriminatory to least: Tap-TEE, Exercise, Dipyridamole, Dobutamine and Adenosine. Weighted means sensitivity/specificity were Exercise: 82.6/84.4%, Adenosine: 68.4/80.9%, Dobutamine: 79.6/85.1%, Dipyridamole: 71.0/92.2%, Tap-TTE: 90.7/86.1%, and Tap-TEE: 86.2/91.3%. Covariate analysis showed that the discriminatory power of Exercise decreased with increasing mean age. Conclusions: Tap-TEE is a very accurate test for both ruling in and ruling out CAD although its invasiveness may limit its clinical acceptability. Exercise is a well-balanced satisfactory test for both ruling in and ruling out but performance might be lower for the elderly. Dobutamine offers a reasonable compromise for Exercise. Dipyridamole might be good for ruling in but not for ruling out CAD. The incapability in ruling-out CAD was a major problem in clinical application of the stress. Adenosine was the least useful stressor in diagnosing CAD.

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Abbreviations

SROC:

summary receiver operator characteristic

TEE:

transesophageal echocardiography

TTE:

transthorasic echocardiography

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Fujita Health University School of Medicine, Toyoake, 1-98 Dengakugakubo, Kutsukake-cho, Aichi prefecture, 470-1192, Japan

    Yoshinori Noguchi

  2. Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Shizuko Nagata-Kobayashi

  3. MGH-Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA

    James E Stahl

  4. Division of Clinical Decision Making, Informatics and Telemedicine in the Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA, USA

    John B Wong

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  1. Yoshinori Noguchi
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  2. Shizuko Nagata-Kobayashi
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  3. James E Stahl
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  4. John B Wong
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Correspondence to Yoshinori Noguchi.

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Noguchi, Y., Nagata-Kobayashi, S., Stahl, J.E. et al. A meta-analytic comparison of echocardiographic stressors. Int J Cardiovasc Imaging 21, 189–207 (2005). https://doi.org/10.1007/s10554-004-5808-x

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  • DOI: https://doi.org/10.1007/s10554-004-5808-x

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