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Umbrella review and multivariate meta-analysis of diagnostic test accuracy studies on hybrid non-invasive imaging for coronary artery disease

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The diagnosis of coronary artery disease (CAD) remains challenging. It is uncertain whether hybrid imaging can improve diagnostic accuracy for CAD.

Methods

This is a systematic review and multivariate meta-analysis. We searched PubMed and The Cochrane Library for recent (≥ 2010) systematic reviews of diagnostic test accuracy studies on non-invasive imaging for CAD. Study-level data were extracted from them, and pooled with pairwise and multivariate meta-analytic methods, using invasive coronary angiography (ICA) or invasive fractional flow reserve (FFR) as reference standards, focusing on sensitivity and specificity.

Results

Details from 661 original studies (71,823 patients) were pooled. Pairwise meta-analysis using ICA as reference showed that anatomic imaging was associated with the best diagnostic accuracy (sensitivity = 0.95 [95% confidence interval 0.94-0.96], specificity = 0.83 [0.81-0.85]), whereas using FFR as reference identified hybrid imaging as the best test (sensitivity = 0.87 [0.83-0.90], specificity = 0.82 [0.76-0.87]). Multivariate meta-analysis confirmed the superiority of anatomic imaging using ICA as reference (sensitivity = 0.96, specificity = 0.83), and hybrid imaging using FFR as reference (sensitivity = 0.88 [0.86-0.91], specificity = 0.82 [0.77-0.87]).

Conclusions

Non-invasive hybrid imaging tests appear superior to anatomic or functional only tests to diagnose ischemia-provoking coronary lesions, whereas anatomic imaging is best to diagnose and/or rule out angiographically significant CAD.

Systematic review registration

PROSPERO Registry Number CRD42018088528.

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Abbreviations

+ LR:

Positive likelihood ratio

− LR:

Negative likelihood ratio

AUC:

Area under the curve

CAD:

Coronary artery disease

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

CT:

Computed tomography

CTFFR:

Computed tomography-fractional flow reserve

CZT:

Cadmium-zinc-telluride

DOR:

Diagnostic odds ratio

ECG:

Electrocardiography

FFR:

Fractional flow reserve

FN:

False negatives

FP:

False positives

ICA:

Invasive coronary angiography

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

PROSPERO:

International Prospective Register of Systematic Reviews

SPECT:

Single photon emission computed tomography

SROC:

Summary receiver-operating curve

TN:

True negatives

TP:

True positives

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Disclosure

Prof. Biondi-Zoccai has consulted for Abbott Vascular and Bayer. Prof. Versaci, Prof. Iskandrian, Prof. Schillaci, Dr. A. Nudi, Prof. Frati and Dr. F. Nudi have nothing to disclose.

Authors Contributions

GZB and FN designed the study, interpreted the results and drafted the manuscript. GBZ, AN, and GF performed searches, extracted data, and appraised them. FV and AEI provided critical input on study design, data analysis, and interpretation. All authors finally approved the manuscript before submission. FN acts as guarantor.

Data Sharing Statement

All data used to generate the analyses reported in this work are attached as an online supplement.

Author information

Authors and Affiliations

  1. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Giuseppe Biondi-Zoccai MD, MStat & Giacomo Frati MD, MSc

  2. IRCCS NEUROMED, Pozzilli, Italy

    Giuseppe Biondi-Zoccai MD, MStat, Orazio Schillaci MD & Giacomo Frati MD, MSc

  3. Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy

    Francesco Versaci MD

  4. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA

    Ami E. Iskandrian MD, MACC

  5. Department of Nuclear Medicine, Tor Vergata University, Rome, Italy

    Orazio Schillaci MD

  6. Replycare, Viale Africa 36, 00144, Rome, Italy

    Alessandro Nudi MD & Francesco Nudi MD

  7. Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy

    Francesco Nudi MD

  8. Service of Nuclear Cardiology, Ostia Radiologica, Rome, Italy

    Francesco Nudi MD

Authors
  1. Giuseppe Biondi-Zoccai MD, MStat
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  2. Francesco Versaci MD
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  6. Giacomo Frati MD, MSc
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  7. Francesco Nudi MD
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Corresponding author

Correspondence to Giuseppe Biondi-Zoccai MD, MStat.

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This work was supported by Replycare, Rome, Italy.

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Biondi-Zoccai, G., Versaci, F., Iskandrian, A.E. et al. Umbrella review and multivariate meta-analysis of diagnostic test accuracy studies on hybrid non-invasive imaging for coronary artery disease. J. Nucl. Cardiol. 27, 1744–1755 (2020). https://doi.org/10.1007/s12350-018-01487-w

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  • DOI: https://doi.org/10.1007/s12350-018-01487-w

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