Myocardial Contrast Echocardiography has Favorable Sensitivity and Specificity for Coronary Artery Disease Diagnosis in Patients with LBBB: A Meta-Analysis
- Corresponding Author:
- Brian D Hoit
Division of Cardiovascular Medicine
Harrington Heart and Vascular Institute
Case Western Reserve University Cleveland, USA
E-mail: [email protected]
Received April 14, 2016; Accepted April 28, 2016; Published May 09, 2016
Citation: Alajaji W, Baydoun A, Morris N, Henry L, Hoit BD (2016) Myocardial Contrast Echocardiography has Favorable Sensitivity and Specificity for Coronary Artery Disease Diagnosis in Patients with LBBB: A Meta-analysis. J Cardiovasc Dis Diagn S1:003. doi:10.4172/2329-9517.S1-003
Copyright: © 2016 Alajaji W, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Conflicting evidence exists on the ideal choice of non-invasive pharmacologic stress imaging for coronary artery disease (CAD) diagnosis in patients with left bundle branch block (LBBB). The aim of this meta-analysis is to compare data that examine the sensitivity and specificity of non-invasive pharmacologic stress imaging in patients with LBBB for obstructive CAD diagnosis. Methods: We performed a literature search in MEDLINE, embase.com and Cochrane (CENTRAL) without publication type or language restrictions. Both pharmacologic stress echocardiography (SE) and nuclear myocardial perfusion imaging (MPI) searches were restricted to the period between January 2004 and review time. Exclusion criteria included studies that lacked sensitivity and specificity data. The primary objective was to compare the sensitivities and specificities of all pharmacologic SE, MPI, myocardial contrast echocardiography (MCE), stress cardiac magnetic resonance (CMR) and positron emission tomography (PET) for identifying significant CAD in patients with LBBB.
Results: 10 studies met the inclusion criteria for analysis. The sensitivity and specificity odds ratio of MCE was 92% (95% CI 81-97%), 93% (95% CI 86- 97%); Dobutamine (D)-CMR 64% (95% CI 42-82%), 94% (95% CI 85-98%); pharmacologic SE 73% (95% CI 55-86%), 84% (95% CI 75-91%); and pharmacologic MPI 83% (95% CI 72-91%), 56% (95% CI 42-70%).
Conclusion: MCE and D-CMR appear to have improved diagnostic accuracy in comparison to pharmacologic SE and MPI in patients with LBBB. Additional MCE and D-CMR studies are warranted given their potential to become the non-invasive gold standard for the diagnosis of CAD in this population.