BACKGROUND: The relative performance of alternative stressors for stress echocardiography for the diagnosis of coronary artery disease (CAD) is not well established. METHODS: All studies published between 1981 to December 2001 who met inclusion criteria were included in this analysis. We performed a summary receiver operator characteristic (SROC) analysis and calculated weighted mean of the likelihood ratio and sensitivity/specificity. A covariate analysis using meta-regression methods was also performed. RESULTS: Forty-four studies presented data on Exercise, 11 on Adenosine, 80 on Dobutamine, 40 on Dipyridamole, 16 on transatrial pacing transesophageal echocardiography (Tap-TEE), and 7 on transatrial pacing transthorasic echocardiography (Tap-TTE). SROC analysis showed that the following order of most discriminatory to least: Tap-TEE, Exercise, Dipyridamole, Dobutamine and Adenosine. Weighted means sensitivity/specificity were Exercise: 82.6/84.4%, Adenosine: 68.4/80.9%, Dobutamine: 79.6/85.1%, Dipyridamole: 71.0/92.2%, Tap-TTE: 90.7/86.1%, and Tap-TEE: 86.2/91.3%. Covariate analysis showed that the discriminatory power of Exercise decreased with increasing mean age. CONCLUSIONS: Tap-TEE is a very accurate test for both ruling in and ruling out CAD although its invasiveness may limit its clinical acceptability. Exercise is a well-balanced satisfactory test for both ruling in and ruling out but performance might be lower for the elderly. Dobutamine offers a reasonable compromise for Exercise. Dipyridamole might be good for ruling in but not for ruling out CAD. The incapability in ruling-out CAD was a major problem in clinical application of the stress. Adenosine was the least useful stressor in diagnosing CAD.
BACKGROUND: The relative performance of alternative stressors for stress echocardiography for the diagnosis of coronary artery disease (CAD) is not well established. METHODS: All studies published between 1981 to December 2001 who met inclusion criteria were included in this analysis. We performed a summary receiver operator characteristic (SROC) analysis and calculated weighted mean of the likelihood ratio and sensitivity/specificity. A covariate analysis using meta-regression methods was also performed. RESULTS: Forty-four studies presented data on Exercise, 11 on Adenosine, 80 on Dobutamine, 40 on Dipyridamole, 16 on transatrial pacing transesophageal echocardiography (Tap-TEE), and 7 on transatrial pacing transthorasic echocardiography (Tap-TTE). SROC analysis showed that the following order of most discriminatory to least: Tap-TEE, Exercise, Dipyridamole, Dobutamine and Adenosine. Weighted means sensitivity/specificity were Exercise: 82.6/84.4%, Adenosine: 68.4/80.9%, Dobutamine: 79.6/85.1%, Dipyridamole: 71.0/92.2%, Tap-TTE: 90.7/86.1%, and Tap-TEE: 86.2/91.3%. Covariate analysis showed that the discriminatory power of Exercise decreased with increasing mean age. CONCLUSIONS: Tap-TEE is a very accurate test for both ruling in and ruling out CAD although its invasiveness may limit its clinical acceptability. Exercise is a well-balanced satisfactory test for both ruling in and ruling out but performance might be lower for the elderly. Dobutamine offers a reasonable compromise for Exercise. Dipyridamole might be good for ruling in but not for ruling out CAD. The incapability in ruling-out CAD was a major problem in clinical application of the stress. Adenosine was the least useful stressor in diagnosing CAD.
Authors: O Gaddi; G Tortorella; E Picano; M Pantaleoni; E Manicardi; A Varga; I Moneta; U Guiducci Journal: Diabet Med Date: 1999-09 Impact factor: 4.359
Authors: V De Bello; C R Bellina; N Molea; L Talarico; G Boni; E Magagnini; F Matteucci; D Giorgi; E Lazzeri; A Bertini; M F Romano; R Bianchi; C Giusti Journal: Int J Card Imaging Date: 1996-09
Authors: E Nagel; H B Lehmkuhl; W Bocksch; C Klein; U Vogel; E Frantz; A Ellmer; S Dreysse; E Fleck Journal: Circulation Date: 1999-02-16 Impact factor: 29.690
Authors: A Elhendy; R T van Domburg; J J Bax; D Poldermans; P R Nierop; J D Kasprzak; J R Roelandt Journal: Am J Cardiol Date: 1998-12-01 Impact factor: 2.778
Authors: T H Marwick; T Anderson; M J Williams; B Haluska; J A Melin; F Pashkow; J D Thomas Journal: J Am Coll Cardiol Date: 1995-08 Impact factor: 24.094
Authors: P Meimoun; J Clerc; D Ardourel; U Djou; S Martis; T Botoro; F Elmkies; H Zemir; A Luycx-Bore; J Boulanger Journal: Int J Cardiovasc Imaging Date: 2016-10-17 Impact factor: 2.357
Authors: Sergey G Kozlov; Olga V Chernova; Elena V Gerasimova; Ekaterina A Ivanova; Alexander N Orekhov Journal: Int J Mol Sci Date: 2020-08-29 Impact factor: 5.923