Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis

Jiancheng Xiu; Kai Cui; Yuegang Wang; Hua Zheng; Gangbin Chen; Qian Feng; Jianping Bin; Juefei Wu; Thomas R Porter

doi:10.1016/j.echo.2016.11.015

Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis

J Am Soc Echocardiogr. 2017 Mar;30(3):270-281. doi: 10.1016/j.echo.2016.11.015. Epub 2016 Dec 31.

Authors

Jiancheng Xiu¹, Kai Cui¹, Yuegang Wang¹, Hua Zheng¹, Gangbin Chen¹, Qian Feng¹, Jianping Bin¹, Juefei Wu², Thomas R Porter³

Affiliations

¹ Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China.
² Department of Cardiology, Nanfang Hospital Southern Medical University, Guangzhou, China. Electronic address: jaffiwu@hotmail.com.
³ Division of Cardiology Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.

PMID: 28049598
DOI: 10.1016/j.echo.2016.11.015

Abstract

Background: Myocardial perfusion (MP) imaging during stress myocardial contrast echocardiography (MCE) improves the detection of coronary artery disease (CAD). However, its prognostic value to predict cardiac events in patients with known or suspected CAD is still undefined.

Methods: A search was conducted for single- or multicenter prospective studies that evaluated the prognostic value of stress MCE in patients with known or suspected CAD. A database search was performed through June 2015. Effect sizes of relative risk ratios (RRs) with their corresponding 95% CIs were used to evaluate the association between the occurrence of total cardiac events (cardiac death, nonfatal myocardial infarction, coronary revascularization) and hard cardiac events (cardiac death and nonfatal myocardial infarction) in subjects with normal and abnormal MP measured by MCE. The Cochran Q statistic and the I² statistic were used to assess heterogeneity.

Results: A comprehensive literature search of the MEDLINE, Google Scholar, Cochrane, and Embase databases identified 11 studies enrolling a total of 4,045 patients. The overall analysis of RRs revealed that patients with abnormal MP were at higher risk for total cardiac events compared with patients with normal MP (RR, 5.58; 95% CI, 3.64-8.57; P < .001), with low heterogeneity among trials (I² = 48.15%, Q = 7.71, P = .103). Similarly, patients with abnormal MP were at higher risk for hard cardiac events compared with patients with normal MP (RR, 4.99; 95% CI, 1.75-14.32; P = .003), with significant heterogeneity among trials (I² = 81.48%, Q = 21.59, P < .001).

Conclusions: The results of this meta-analysis suggest that MP assessment using stress MCE is an effective prognostic tool for predicting the occurrence of cardiac events in patients with known or suspected CAD.

Keywords: Coronary artery disease; Myocardial contrast echocardiography; Myocardial perfusion; Prognosis; Stress echocardiography.

Publication types

Meta-Analysis
Review

MeSH terms

Aged
Causality
Comorbidity
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / mortality*
Death, Sudden, Cardiac / epidemiology*
Echocardiography, Stress / methods
Echocardiography, Stress / statistics & numerical data*
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnostic imaging*
Myocardial Infarction / mortality*
Myocardial Perfusion Imaging / methods
Myocardial Perfusion Imaging / statistics & numerical data*
Prevalence
Prognosis
Proportional Hazards Models
Risk Assessment / methods
Survival Analysis