Ruurt A Jukema, Jorge Dahdal, Eline M Kooijman, Ellaha Wahedi, Ruben W de Winter, Marco Guglielmo, Maarten Jan Cramer, Pim van der Harst, Sharon Remmelzwaal, Pieter Raijmakers, Paul Knaapen, Ibrahim Danad
{"title":"非侵入性心脏成像模式对有冠状动脉疾病史患者的诊断准确性：一项荟萃分析。","authors":"Ruurt A Jukema, Jorge Dahdal, Eline M Kooijman, Ellaha Wahedi, Ruben W de Winter, Marco Guglielmo, Maarten Jan Cramer, Pim van der Harst, Sharon Remmelzwaal, Pieter Raijmakers, Paul Knaapen, Ibrahim Danad","doi":"10.1136/heartjnl-2024-324248","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The diagnostic performance of non-invasive imaging techniques for detecting obstructive coronary artery disease (CAD) in patients with a history of myocardial infarction or percutaneous coronary intervention has not been comprehensively evaluated. This meta-analysis assesses the diagnostic value of coronary CT angiography (CCTA), CCTA combined with CT perfusion (CCTA+CTP), cardiac MRI (CMR) and single-photon emission CT (SPECT) compared with invasive reference standards.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science and the Cochrane Library from 2005 to September 2022 for prospective, blinded studies including populations with ≥50% prior CAD.</p><p><strong>Results: </strong>We identified 18 studies encompassing 3265 patients, with obstructive CAD present in 64%. The per-patient sensitivity of CCTA (0.95; 95% CI 0.92 to 0.98), CCTA+CTP (0.93; 95% CI 0.84 to 0.98) and CMR (0.91; 95% CI 0.86 to 0.94) was high, while SPECT showed lower sensitivity (0.63; 95% CI 0.52 to 0.73). SPECT had higher specificity compared with CCTA (0.66; 95% CI 0.56 to 0.76 vs 0.37; 95% CI 0.29 to 0.46), but was comparable to CCTA+CTP (0.59; 95% CI 0.49 to 0.69) and CMR (0.69; 95% CI 0.53 to 0.81). The area under the curve for SPECT was the lowest (0.70; 95% CI 0.58 to 0.87), while CCTA (0.91; 95% CI 0.86 to 0.98), CCTA+CTP (0.89; 95% CI 0.73 to 1.00) and CMR (0.91; 95% CI 0.80 to 1.00) showed similar high values.</p><p><strong>Conclusions: </strong>In patients with prior CAD, CCTA, CCTA+CTP and CMR demonstrated high diagnostic performance, whereas SPECT had lower sensitivity. These findings can guide the selection of non-invasive imaging techniques in this high-risk population.</p><p><strong>Prospero registration number: </strong>CRD42022322348.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":null,"pages":null},"PeriodicalIF":5.1000,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic accuracy of non-invasive cardiac imaging modalities in patients with a history of coronary artery disease: a meta-analysis.\",\"authors\":\"Ruurt A Jukema, Jorge Dahdal, Eline M Kooijman, Ellaha Wahedi, Ruben W de Winter, Marco Guglielmo, Maarten Jan Cramer, Pim van der Harst, Sharon Remmelzwaal, Pieter Raijmakers, Paul Knaapen, Ibrahim Danad\",\"doi\":\"10.1136/heartjnl-2024-324248\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The diagnostic performance of non-invasive imaging techniques for detecting obstructive coronary artery disease (CAD) in patients with a history of myocardial infarction or percutaneous coronary intervention has not been comprehensively evaluated. This meta-analysis assesses the diagnostic value of coronary CT angiography (CCTA), CCTA combined with CT perfusion (CCTA+CTP), cardiac MRI (CMR) and single-photon emission CT (SPECT) compared with invasive reference standards.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science and the Cochrane Library from 2005 to September 2022 for prospective, blinded studies including populations with ≥50% prior CAD.</p><p><strong>Results: </strong>We identified 18 studies encompassing 3265 patients, with obstructive CAD present in 64%. The per-patient sensitivity of CCTA (0.95; 95% CI 0.92 to 0.98), CCTA+CTP (0.93; 95% CI 0.84 to 0.98) and CMR (0.91; 95% CI 0.86 to 0.94) was high, while SPECT showed lower sensitivity (0.63; 95% CI 0.52 to 0.73). SPECT had higher specificity compared with CCTA (0.66; 95% CI 0.56 to 0.76 vs 0.37; 95% CI 0.29 to 0.46), but was comparable to CCTA+CTP (0.59; 95% CI 0.49 to 0.69) and CMR (0.69; 95% CI 0.53 to 0.81). The area under the curve for SPECT was the lowest (0.70; 95% CI 0.58 to 0.87), while CCTA (0.91; 95% CI 0.86 to 0.98), CCTA+CTP (0.89; 95% CI 0.73 to 1.00) and CMR (0.91; 95% CI 0.80 to 1.00) showed similar high values.</p><p><strong>Conclusions: </strong>In patients with prior CAD, CCTA, CCTA+CTP and CMR demonstrated high diagnostic performance, whereas SPECT had lower sensitivity. These findings can guide the selection of non-invasive imaging techniques in this high-risk population.</p><p><strong>Prospero registration number: </strong>CRD42022322348.</p>\",\"PeriodicalId\":12835,\"journal\":{\"name\":\"Heart\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2024-08-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/heartjnl-2024-324248\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/heartjnl-2024-324248","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：对于有心肌梗死或经皮冠状动脉介入治疗史的患者，无创成像技术在检测阻塞性冠状动脉疾病（CAD）方面的诊断性能尚未进行全面评估。本荟萃分析评估了冠状动脉 CT 血管造影（CCTA）、CCTA 联合 CT 灌注（CCTA+CTP）、心脏磁共振成像（CMR）和单光子发射 CT（SPECT）与有创参考标准相比的诊断价值：我们系统检索了2005年至2022年9月期间在PubMed、Embase、Web of Science和Cochrane图书馆进行的前瞻性盲法研究，研究对象包括既往CAD≥50%的人群：我们确定了 18 项研究，涵盖 3265 名患者，其中 64% 的患者存在阻塞性 CAD。CCTA（0.95；95% CI 0.92-0.98）、CCTA+CTP（0.93；95% CI 0.84-0.98）和CMR（0.91；95% CI 0.86-0.94）对每位患者的敏感性较高，而SPECT的敏感性较低（0.63；95% CI 0.52-0.73）。SPECT的特异性高于CCTA（0.66；95% CI 0.56至0.76 vs 0.37；95% CI 0.29至0.46），但与CCTA+CTP（0.59；95% CI 0.49至0.69）和CMR（0.69；95% CI 0.53至0.81）相当。SPECT的曲线下面积最低（0.70；95% CI 0.58至0.87），而CCTA（0.91；95% CI 0.86至0.98）、CCTA+CTP（0.89；95% CI 0.73至1.00）和CMR（0.91；95% CI 0.80至1.00）显示出相似的高值：对于既往有 CAD 的患者，CCTA、CCTA+CTP 和 CMR 具有较高的诊断性能，而 SPECT 的灵敏度较低。这些发现可以指导这类高危人群选择无创成像技术：CRD42022322348。
Diagnostic accuracy of non-invasive cardiac imaging modalities in patients with a history of coronary artery disease: a meta-analysis.
Background: The diagnostic performance of non-invasive imaging techniques for detecting obstructive coronary artery disease (CAD) in patients with a history of myocardial infarction or percutaneous coronary intervention has not been comprehensively evaluated. This meta-analysis assesses the diagnostic value of coronary CT angiography (CCTA), CCTA combined with CT perfusion (CCTA+CTP), cardiac MRI (CMR) and single-photon emission CT (SPECT) compared with invasive reference standards.
Methods: We systematically searched PubMed, Embase, Web of Science and the Cochrane Library from 2005 to September 2022 for prospective, blinded studies including populations with ≥50% prior CAD.
Results: We identified 18 studies encompassing 3265 patients, with obstructive CAD present in 64%. The per-patient sensitivity of CCTA (0.95; 95% CI 0.92 to 0.98), CCTA+CTP (0.93; 95% CI 0.84 to 0.98) and CMR (0.91; 95% CI 0.86 to 0.94) was high, while SPECT showed lower sensitivity (0.63; 95% CI 0.52 to 0.73). SPECT had higher specificity compared with CCTA (0.66; 95% CI 0.56 to 0.76 vs 0.37; 95% CI 0.29 to 0.46), but was comparable to CCTA+CTP (0.59; 95% CI 0.49 to 0.69) and CMR (0.69; 95% CI 0.53 to 0.81). The area under the curve for SPECT was the lowest (0.70; 95% CI 0.58 to 0.87), while CCTA (0.91; 95% CI 0.86 to 0.98), CCTA+CTP (0.89; 95% CI 0.73 to 1.00) and CMR (0.91; 95% CI 0.80 to 1.00) showed similar high values.
Conclusions: In patients with prior CAD, CCTA, CCTA+CTP and CMR demonstrated high diagnostic performance, whereas SPECT had lower sensitivity. These findings can guide the selection of non-invasive imaging techniques in this high-risk population.
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
