Diagnostic Accuracy of Stress Myocardial Perfusion Imaging Compared to Invasive Coronary Angiography With Fractional Flow Reserve Meta-Analysis
Diagnostic Accuracy of Stress Myocardial Perfusion Imaging Compared to Invasive Coronary Angiography With Fractional Flow Reserve Meta-Analysis
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DOI：
10.1161/circimaging.114.002666
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发表时间：
2015-01-01
影响因子：
7.5
通讯作者：
Leiner, Tim
中科院分区：
文献类型：
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作者：
Takx, Richard A. P.;Blomberg, Bjorn A.;Leiner, Tim
背景-血流动力学显著的冠状动脉疾病是血运重建的重要指征。负荷心肌灌注显像是一种无创的替代有创血流储备分数的评价血流动力学显着的冠状动脉疾病。目的是确定心肌灌注成像的诊断准确性，单光子发射计算机断层扫描，超声心动图，MRI，正电子发射断层扫描，计算机断层扫描相比，有创冠状动脉造影血流储备分数诊断血流动力学显着的冠状动脉diseases.Methods和Results-the荟萃分析坚持首选报告项目的系统评价和荟萃分析声明。检索PubMed、EMBASE和Web of Science，直至2014年5月。纳入了37项研究，报告了4721例血管和2048例患者。荟萃分析得出合并敏感性、合并特异性、合并似然比（LR）、合并诊断优势比和接受者工作特征曲线下面积。选择阴性LR（NLR）作为主要结局。在血管水平，MRI（合并NLR，0.16; 95%置信区间[CI]，0.13-0.21）与计算机断层扫描相似（合并NLR，0.22; 95% CI，0.12-0.39）和正电子发射断层扫描（合并NLR，0.15; 95% CI，0.05-0.44），优于单光子发射计算机断层扫描（合并NLR，0.47; 95% CI，0.37-0.59）。在患者层面，MRI（汇总NLR，0.14; 95% CI，0.10-0.18）与计算机断层扫描相似（合并NLR，0.12; 95% CI，0.04-0.33）和正电子发射断层扫描（合并NLR，0.14; 95% CI，0.02-0.87），优于单光子发射计算机断层扫描（合并NLR，0.39; 95% CI，0.27-0.55）和超声心动图（合并NLR，0.42; 95%CI，0.30-0.59）。结论-负荷心肌灌注成像与MRI，计算机断层扫描，或正电子发射断层扫描可以准确地排除血流动力学上显著的冠状动脉疾病，并且可以作为侵入性血管重建的看门人。单光子发射计算机断层扫描和超声心动图不太适用于此目的。
Background-Hemodynamically significant coronary artery disease is an important indication for revascularization. Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating hemodynamically significant coronary artery disease. The aim was to determine the diagnostic accuracy of myocardial perfusion imaging by single-photon emission computed tomography, echocardiography, MRI, positron emission tomography, and computed tomography compared with invasive coronary angiography with fractional flow reserve for the diagnosis of hemodynamically significant coronary artery disease.Methods and Results-The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. PubMed, EMBASE, and Web of Science were searched until May 2014. Thirty-seven studies, reporting on 4721 vessels and 2048 patients, were included. Meta-analysis yielded pooled sensitivity, pooled specificity, pooled likelihood ratios (LR), pooled diagnostic odds ratio, and summary area under the receiver operating characteristic curve. The negative LR (NLR) was chosen as the primary outcome. At the vessel level, MRI (pooled NLR, 0.16; 95% confidence interval [CI], 0.13-0.21) was performed similar to computed tomography (pooled NLR, 0.22; 95% CI, 0.12-0.39) and positron emission tomography (pooled NLR, 0.15; 95% CI, 0.05-0.44), and better than single-photon emission computed tomography (pooled NLR, 0.47; 95% CI, 0.37-0.59). At the patient level, MRI (pooled NLR, 0.14; 95% CI, 0.10-0.18) performed similar to computed tomography (pooled NLR, 0.12; 95% CI, 0.04-0.33) and positron emission tomography (pooled NLR, 0.14; 95% CI, 0.02-0.87), and better than single-photon emission computed tomography (pooled NLR, 0.39; 95% CI, 0.27-0.55) and echocardiography (pooled NLR, 0.42; 95% CI, 0.30-0.59).Conclusions-Stress myocardial perfusion imaging with MRI, computed tomography, or positron emission tomography can accurately rule out hemodynamically significant coronary artery disease and can act as a gatekeeper for invasive revascularization. Single-photon emission computed tomography and echocardiography are less suited for this purpose.