Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis

Abstract

Background: Both coronary computed tomography angiography (CCTA) and exercise electrocardiography (ExECG) are non-invasive testing methods for the evaluation of coronary artery disease (CAD). However, there was controversy on the diagnostic performance of these methods due to the limited data in each single study. Therefore, we performed a meta-analysis to address these issues. Methods: We searched PubMed and Embase databases up to May 22, 2015. Two authors identified eligible studies, extracted data and accessed quality. Pooled estimation of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver-operating characteristic curve (SROC) and the area under curve (AUC) of CCTA and ExECG for the diagnosis of CAD were calculated using Stata, Meta-Disc and Review Manager statistical software. and 0.7727±0.0638, respectively. There is no heterogeneity caused by threshold effect in CCTA or ExECG analysis. The Deeks' test showed no potential publication bias (P=0.17).Conclusions: CCTA has better diagnostic performance than ExECG in the evaluation of CAD, which can provide a better solution for the clinical problem of the diagnosis for CAD. J Thorac Dis 2016;8(7):1688-1696 jtd.amegroups.com standard for assessing anatomical stenosis severity, a variety of non-invasive testing methods have been advocated recently to provide an anatomic and/or functional evaluation of coronary artery. Available methods include exercise/stress electrocardiography (ExECG), single proton emission computed tomography (SPECT), myocardial perfusion imaging (MPI), coronary computed tomography angiography (CCTA) and coronary computed tomography with fractional flow reserve (FFRCT). Despite these facts, assessment of the presence of CAD remains challenging.Among these diagnostic methods, ExECG is a wellestablished and inexpensive procedure to evaluate intermediate risk patients with angina pectoris (2). However, ExECG has relatively limited diagnostic performance in patients with silent CAD (3). As a new non-invasive alternative test, CCTA has high diagnostic performance to rule out CAD (4,5). Moreover, CCTA can be used in patients with equivocal stress test or unable to exercise stress test (6). But this method also suffers a number of limitations, such as a progressive loss of sensitivity and specificity as the pretest probability of disease decreases (7).To date, several studies have compared the effectiveness of CCTA with that of ExECG for the diagnosis of CAD (8)(9)(10)(11)(12)(13)(14). But there was controversy about the specificity of two arms (12,13). Additionally, a major limitation of these investigations was their reliance, by necessity, on observational studies due to the limited data in each single study. Therefore, we performed a meta-analysis to compare the diagnostic performance of CCTA and ExECG for CAD based on a larger data, which indicates a more specific comparison about the value of anatomic and functional evaluation in clinical decisions. Methods ...

Coronary computed tomographic angiography imaging as a prognostic indicator for coronary artery disease: Data from a lebanese tertiary center

“…With respect to our NPV, its lower result as compared to others (97%–100%)[ 11 12 ] can be explained by the difference in the sample size studied, ethnicity, and the longer follow-up period (5–8 years in our study compared to a mean of 2 years in other studies).…”

“…This PPV goes in the same average of a wide range of PPV values present in the literature (35%–97%). [ 9 10 11 ] This relatively low PPV can be explained by the overestimation of the coronary artery narrowing detected by CCTA, secondary to blurring artifacts.…”

Marijuana use and coronary artery disease in young adults

“…Transient coronary vasospasm is also a potential cause as suggested by a few published case reports [14][15][16]. Although CCTA has excellent negative predictive value for diagnosing CAD [17], Kang et al found poor sensitivity of CCTA for diagnosing coronary vasospasm [18]. This is another topic that requires further investigation in patients using cannabis.…”

A case of anomalous aortic origin of coronary arteries from the opposite sinus

“…Noteworthy, our method routinely permits very low radiation exposures (<2 mSv), low contrast volumes, and rapid imaging by free breathing without sedation. MDCT is the best non-invasive imaging technique in terms of sensibility, specifi city, positive and negative predictive value as regard this group of malformations [6]. Non-contrast Self-navigated Free-breathing MR Angiography (SN3D-MRA) studies provide considerable diagnostic accuracy regarding the detection of anomalies, high origin, and inter-arterial course of the coronary arteries.…”