Anatomy of a meta-analysis: A critical review of "Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance"

Steven M. Kymes, Denise E. Bruns, Leslee J. Shaw, Kathleen N. Gillespie, James Fletcher

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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 meta-analysis. 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.

Original languageEnglish (US)
Pages (from-to)599-611
Number of pages13
JournalJournal of Nuclear Cardiology
Volume7
Issue number6
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

Single-Photon Emission-Computed Tomography
Routine Diagnostic Tests
Echocardiography
Meta-Analysis
Anatomy
ROC Curve
Radioisotopes
Health Services
Coronary Disease
Reading
Costs and Cost Analysis

Keywords

  • Confidence intervals
  • Coronary artery disease
  • Diagnostic tests
  • Meta-analysis
  • Summary receiver operating characteristics curve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Anatomy of a meta-analysis : A critical review of "Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance". / Kymes, Steven M.; Bruns, Denise E.; Shaw, Leslee J.; Gillespie, Kathleen N.; Fletcher, James.

In: Journal of Nuclear Cardiology, Vol. 7, No. 6, 2000, p. 599-611.

Research output: Contribution to journalArticle

@article{9168e63fee9c4d3f9bcb5e28ff269be3,
title = "Anatomy of a meta-analysis: A critical review of {"}Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance{"}",
abstract = "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 meta-analysis. 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.",
keywords = "Confidence intervals, Coronary artery disease, Diagnostic tests, Meta-analysis, Summary receiver operating characteristics curve",
author = "Kymes, {Steven M.} and Bruns, {Denise E.} and Shaw, {Leslee J.} and Gillespie, {Kathleen N.} and James Fletcher",
year = "2000",
doi = "10.1067/mnc.2000.109027",
language = "English (US)",
volume = "7",
pages = "599--611",
journal = "Journal of Nuclear Cardiology",
issn = "1071-3581",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - Anatomy of a meta-analysis

T2 - A critical review of "Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance"

AU - Kymes, Steven M.

AU - Bruns, Denise E.

AU - Shaw, Leslee J.

AU - Gillespie, Kathleen N.

AU - Fletcher, James

PY - 2000

Y1 - 2000

N2 - 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 meta-analysis. 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.

AB - 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 meta-analysis. 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.

KW - Confidence intervals

KW - Coronary artery disease

KW - Diagnostic tests

KW - Meta-analysis

KW - Summary receiver operating characteristics curve

UR - http://www.scopus.com/inward/record.url?scp=0034518137&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034518137&partnerID=8YFLogxK

U2 - 10.1067/mnc.2000.109027

DO - 10.1067/mnc.2000.109027

M3 - Article

C2 - 11144475

AN - SCOPUS:0034518137

VL - 7

SP - 599

EP - 611

JO - Journal of Nuclear Cardiology

JF - Journal of Nuclear Cardiology

SN - 1071-3581

IS - 6

ER -