Comparison of low-dose dobutamine stress echocardiography and single photon emission computed tomography and delayed contrast MRI in the diagnosis of myocardial viability: Meta-analysis

Abstract

Objective To assess the diagnostic value of different imaging methods including low-dose dobutamine stress echocardiography, SPECT and contrast enhancement MRI with Meta-analysis in the diagnosis of myocardial viability. Methods Articles published from 1998 to 2008 were searched in Cochrane library, Medline, Embase database, OVID database and CNKI for relevant English and Chinese articles. According to the criteria for diagnostic research published by Cochrane Method Group on screening and diagnostic tests, each article was critically screened and appraised, including the absolute numbers of true-positive, false-negative, true-negative, and false-positive. Statistical analysis was performed employing Meta-test Heterogeneity was tested, pooled weighted sensitivity and specificity and the corresponding 95% CI were calculated. Characteristic (SROC) curve was performed and the area under the curve was calculated. Finally, sensitivity analysis was performed. Results Twenty-one of 438 retrieved articles were included, in which there were ten articles about Low-dose dubutamine stress echocardiography, and six articles about 99Tcm-MIBI/99Tcm-Tetrofosmin SPECT, and six articles about contrast enhancement MRI, and one of both 99Tcm-MIBI/99Tcm-tetrofosmin SPECT and contrast enhancement MRI. All groups had heterogeneity, and a random effects regression was developed. The pooled weighted sensitivity and specificity and area under SROC curve for low-dose dobutamine stress echocardiography to diagnose myocardial viability was 0.73(0.62-0. 82)/0. 82 (0.77-0. 86) and 87.07% respectively. They were 0. 82 (0. 59-0. 94)/ 0. 77(0. 64-0. 86) and 86. 97% for 99Tcm-MIBI/99Tcm-Tetrofosmin SPECT respectively, while they were 0. 94 (0. 86-0. 97)/0. 75 (0. 66-0. 83) and 91.41% for contrast enhancement MRI respectively. Conclusion As noninvasive testing technologies, low-dose dobutamine stress echocardiography and 99Tcm-MIBI/99Tcm-tetrofosmin SPECT and delayed contrast enhanced MRI allow the identification of viable myocardium, but delayed contrast enhanced MRI showed significant different pooled sensitivity in comparison to low-dese dobutamine stress echocardiography. Key words: Myocardium; Echocardiography; Tomography; emission-computed; single-photon; Magnetic resonance imaging; Meta-analysis