Diagnostic accuracy of dobutamine stress echocardiography in the detection of cardiac allograft vasculopathy in heart transplant recipients: A systematic review and meta‐analysis study.
Background: Dobutamine stress echocardiography (DSE) is a well‐established imaging modality used to screen patients with mild‐to‐moderate risk for coronary artery disease. In heart transplantation recipients, cardiac allograft vasculopathy (CAV) is a common and lethal complication. The use of DSE to...
| Publicado en: | Echocardiography Vol. 36; no. 3; pp. 528 - 537 |
|---|---|
| Autores principales: | , , , , , |
| Formato: | research systematic review Journal Article |
| Publicado: |
Wiley-Blackwell
Mar2019
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=135293427&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 135293427 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 07422822 GSE jtl: Echocardiography issn: 07422822 maglogo: Y pubinfo: dt: Mar2019 vid: 36 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 135293427 135293427 135293427 10.1111/echo.14268 135293427 ppf: 528 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Diagnostic accuracy of dobutamine stress echocardiography in the detection of cardiac allograft vasculopathy in heart transplant recipients: A systematic review and meta‐analysis study. aug: au: Elkaryoni, Ahmed Abu‐Sheasha, Ghada Altibi, Ahmed M. Hassan, Adil Ellakany, Karim Nanda, Navin C. affil: Division of Internal Medicine, University of Missouri Kansas City, Kansas City Missouri sug: subj: Heart Transplantation Adverse Effects Transplant Recipients Cardiovascular Diseases Radiography Echocardiography Methods Dobutamine Diagnostic Use Sensitivity and Specificity Evaluation Human Systematic Review Meta Analysis PubMed Cochrane Library Embase Confidence Intervals Odds Ratio ROC Curve Chi Square Test ab: Background: Dobutamine stress echocardiography (DSE) is a well‐established imaging modality used to screen patients with mild‐to‐moderate risk for coronary artery disease. In heart transplantation recipients, cardiac allograft vasculopathy (CAV) is a common and lethal complication. The use of DSE to detect CAV showed promising results initially, but later studies showed limitation in its use to detect CAV. It is unclear if this cohort of patients derives benefit from DSE. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Scopus from inception through March 2018 for studies examining the accuracy of DSE in correlation to coronary angiography (CA) or intravascular ultrasound (IVUS) to detect CAV. Original studies comparing the ability of DSE to detect CAV in comparison with CA or IVUS were included. Relevant data were extracted and hierarchical summary receiver operating characteristic analysis was conducted to test the overall diagnostic accuracy of DSE for patients with CAV. Results: Eleven studies (749 participants) met the inclusion criteria. The sensitivity of DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%. Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%–82.3%) and specificity 85.7% (95% CI, 73.8%–92.7%). DSE had an overall diagnostic odds ratio (OR) of 9.1 (95% CI, 4.6–17.8), positive likelihood ratio (LR+) of 4.1 (95% CI, 2.8–6.1), negative likelihood ratio (LR−) of 0.47 (95% CI: 0.23–0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72–0.75). Heterogeneity among studies was not statistically significant (τ2 = 0.32, Cochran's Q = 9.5, P = 0.483). Conclusion: Dobutamine stress echocardiography has a limited sensitivity to detect early CAV but its specificity is much higher. There remains a need for an alternative noninvasive modality which will have both high sensitivity and high specificity for detecting CAV. pubtype: Academic Journal doctype: meta analysis research systematic review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|