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Title Anatomy of a meta-analysis: A critical review of “Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance”
Edition Volume 7, Number 6
Call Number
ISBN/ISSN 1071-3581
Author(s) Kymes, Steven M.
Bruns, Denise E.
Shaw, Leslee J.
Gillespie, Kathleen N.
Fletcher, James W.
Series Title Journal of Nuclear Cardiology
GMD Electronic Journal
Language English
Publisher Springer New York
Publishing Year
Publishing Place New York
Collation 17p
Abstract/Notes Background. Accurate diagnosis of coronary heart disease has the potential to contribute
substantially to cost-effective delivery of health services. Recent work by Fleischmann et al
(JAMA 1998;280:913-20) represents an effort to summarize the accuracy of exercise echocardiography
and exercise single photon emission computed tomography (SPECT).
Methods and Results. A critique of the previous work was constructed, obtaining the 44 articles
used. These articles were reviewed and summarized with established techniques for metaanalysis.
The studies summarized by Fleischmann et al were found to be significantly heterogeneous
(echocardiography and SPECT, both P < .001). In the SPECT cohort, combination of
different radioisotopes and reading techniques, and inclusion of reports using experimental techniques,
were sources of heterogeneity. In the echocardiography cohort, experimental techniques
and an individual series were identified. When the sample was stratified for sources of heterogeneity,
it was found that there was no significant difference in diagnostic accuracy between the
echocardiography and SPECT techniques used in current clinical practice. Meta-regression with
summary receiver operating characteristic curve techniques, after adjustment of the model for
multicolinearity and outliers, revealed that there were no significant differences between SPECT
as used in current clinical practice and echocardiography.
Conclusion. The report by Fleischmann et al contains serious flaws that limit its validity and
generalizability. (J Nucl Cardiol 2000;7:599-615.)
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