Diagnostic accuracy of myocardial perfusion imaging in patients evaluated for kidney transplantation: A systematic review and meta-analysis
Cardiovascular disease is the most common cause of death after kidney transplantation. Coronary artery disease (CAD) assessment is therefore mandatory in patients evaluated for transplantation. We aimed to assess the diagnostic accuracy for CAD of single-photon emission computed tomography (SPECT) compared to the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) in patients evaluated for kidney transplantation.
METHODS:We performed a systematic literature search in PubMed, EMBASE, Web of Science, OvidSP (Medline), The Cochrane Library and Google Scholar. Studies investigating the diagnostic accuracy of myocardial perfusion imaging (MPI) SPECT in patients evaluated for kidney transplantation were retrieved. After a risk of bias assessment using QUADAS-2, a meta-analysis was conducted.
RESULTS:Out of 1459 records, 13 MPI SPECT studies were included in the meta-analysis with a total of 1245 MPI SPECT scans. There were no studies available with CCTA as reference. Pooled sensitivity of MPI SPECT for CAD was 0.66 (95% CI 0.53 to 0.77), pooled specificity was 0.75 (95% CI 0.63 to 0.84) and the area under the curve (AUC) was 0.76. Positive likelihood ratio was 2.50 (95% CI 1.78 to 3.51) and negative likelihood ratio was 0.41 (95% CI 0.28 to 0.61). Pooled positive predictive value was 64.9% and pooled negative predictive value was 74.1%. Significant heterogeneity existed across the included studies.
CONCLUSIONS:MPI SPECT had a moderate diagnostic accuracy in patients evaluated for kidney transplantation, with a high rate of false-negative findings. The use of an anatomical gold standard against a functional imaging test in the included studies is however suboptimal.
CET Conclusion
| Reviewer: | Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | This systematic review investigates the diagnostic accuracy of myocardial perfusion imaging in the evaluation of kidney transplant candidates. In 13 studies, pooled sensitivity was 0.66, specificity 0.75 and AUC 0.76. Heterogeneity was high. The authors conclude that diagnostic accuracy is moderate, with a high rate of false-negative findings. Methodology and reporting of the review are very good, with comprehensive search strategies and low risk of bias in included studies. Conclusions are limited by the degree of heterogeneity (possibly due to differing thresholds for CAD diagnosis and changes in study protocols) and lack of use of CT coronary angiography for comparison (all studies used invasive coronary angiography). |
Study Details
| Aims: | The aim of this study was to compare the diagnostic accuracy of single photon emission computed tomography (SPECT) versus the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) for coronary artery disease (CAD) assessment in kidney transplant candidates. |
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| Interventions: | Electronic databases, including the Cochrane Library, PubMed, Web of Science, EMBASE, OvidSP (Medline) and Google Scholar were searched. Study selection was performed by two independent reviewers. Two reviewers independently assessed the risk of bias using the QUADAS-2 tool. |
| Participants: | 13 studies were included in the review. |
| Outcomes: | The outcomes of interest were sensitivity, specificity, area under the curve (AUC), likelihood ratio (positive and negative), diagnostic odds ratio (DOR) and pooled CAD prevalence. |
| Follow Up: | N/A |
Metadata
| Funding: | No funding was received for this study |
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| Publication type: | Meta-Analysis, Review, Systematic Review |
| Review registration: | PROSPERO - CRD42020188610 |
| Organ: | Kidney |
| Language: | English |
| Author email: | r.h.j.a.slart@umcg.nl |
| MeSH terms: | Humans; Myocardial Perfusion Imaging; Kidney Transplantation; Coronary Artery Disease; Coronary Angiography; Tomography, X-Ray Computed; Tomography, Emission-Computed, Single-Photon |