Document Detail

A meta-analytic comparison of echocardiographic stressors.
MedLine Citation:
PMID:  16015428     Owner:  NLM     Status:  MEDLINE    
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.
Yoshinori Noguchi; Shizuko Nagata-Kobayashi; James E Stahl; John B Wong
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The international journal of cardiovascular imaging     Volume:  21     ISSN:  1569-5794     ISO Abbreviation:  Int J Cardiovasc Imaging     Publication Date:    2005 Apr-Jun
Date Detail:
Created Date:  2005-07-14     Completed Date:  2006-01-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100969716     Medline TA:  Int J Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  189-207     Citation Subset:  IM    
Division of General Internal Medicine, Department of Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
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MeSH Terms
Adenosine / diagnostic use
Age Factors
Cardiac Pacing, Artificial
Coronary Artery Disease / diagnosis*
Dipyridamole / diagnostic use
Echocardiography / methods*
Exercise Test
Multivariate Analysis
ROC Curve
Sensitivity and Specificity
Sex Factors
Vasodilator Agents / diagnostic use
Reg. No./Substance:
0/Vasodilator Agents; 58-32-2/Dipyridamole; 58-61-7/Adenosine
Comment In:
Int J Cardiovasc Imaging. 2005 Apr-Jun;21(2-3):209-11   [PMID:  16015429 ]

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