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   umbrella review and multivariate meta-analysis of diagnostic test accuracy studies on hybrid non-invasive imaging for coronary artery disease  
   
نویسنده biondi-zoccai giuseppe ,versaci francesco ,iskandrian ami e. ,schillaci orazio ,nudi alessandro ,frati giacomo ,nudi francesco
منبع journal of nuclear cardiology - 2020 - دوره : 27 - شماره : 5 - صفحه:1744 -1755
چکیده    The diagnosis of coronary artery disease (cad) remains challenging. it is uncertain whether hybrid imaging can improve diagnostic accuracy for cad. this is a systematic review and multivariate meta-analysis. we searched pubmed and the cochrane library for recent (≥ 2010) systematic reviews of diagnostic test accuracy studies on non-invasive imaging for cad. study-level data were extracted from them, and pooled with pairwise and multivariate meta-analytic methods, using invasive coronary angiography (ica) or invasive fractional flow reserve (ffr) as reference standards, focusing on sensitivity and specificity. details from 661 original studies (71,823 patients) were pooled. pairwise meta-analysis using ica as reference showed that anatomic imaging was associated with the best diagnostic accuracy (sensitivity = 0.95 [95% confidence interval 0.94-0.96], specificity = 0.83 [0.81-0.85]), whereas using ffr as reference identified hybrid imaging as the best test (sensitivity = 0.87 [0.83-0.90], specificity = 0.82 [0.76-0.87]). multivariate meta-analysis confirmed the superiority of anatomic imaging using ica as reference (sensitivity = 0.96, specificity = 0.83), and hybrid imaging using ffr as reference (sensitivity = 0.88 [0.86-0.91], specificity = 0.82 [0.77-0.87]). non-invasive hybrid imaging tests appear superior to anatomic or functional only tests to diagnose ischemia-provoking coronary lesions, whereas anatomic imaging is best to diagnose and/or rule out angiographically significant cad. prospero registry number crd42018088528.
کلیدواژه coronary artery disease ,diagnosis ,imaging ,multivariate meta-analysis ,umbrella review
آدرس sapienza university of rome, department of medico-surgical sciences and biotechnologies, italy. irccs neuromed, italy, s. maria goretti hospital, division of cardiology, italy, university of alabama at birmingham, division of cardiovascular disease, usa, irccs neuromed, italy. tor vergata university, department of nuclear medicine, italy, replycare, italy, sapienza university of rome, department of medico-surgical sciences and biotechnologies, italy. irccs neuromed, italy, replycare, italy. madonna della fiducia clinic, italy. service of nuclear cardiology, ostia radiologica, italy
 
     
   
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