Abstract 11295: Diagnostic Accuracy of Dobutamine Stress Echocardiography in the Detection of Cardiac Allograft Vasculopathy in Heart Transplant Recipients: A Systematic Review and Meta-Analysis Study

IntroductionCardiac allograft vasculopathy (CAV) is an important cause of death after the first year following cardiac transplantation. The absence of classic signs of myocardial ischemia because of cardiac denervation and the presence of concentric hypertrophy tend to prevent early recognition. Currently, cardiac catheterization (CC) and intravascular ultrasound represent the gold standard for identifying CAV but their use is limited due to high cost, limited number of trained professionals, and risk of contrast toxicity in patients with underlying kidney disease especially those using nephrotoxic immunosuppressive medication. Hence, there is a need to find a noninvasive alternative to CC. Dobutamine stress echocardiography (DSE), a noninvasive technique, initially showed promise but later studies showed limitations in predicting CAV.HypothesisWe conducted a systematic literature review and meta-analysis to assess the effectiveness of DSE in detecting CAVMethodsWe searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from inception till January 2018. Original articles that compared the diagnostic accuracy of DSE for early CAV detection were included. Relevant data were extracted and analyzed using RevMan version 5.3 for window and summary receiver-operating characteristic (SROC) curve was constructed.ResultsSeven studies with 606 patients were included. The study quality ranged from low to high according to QUADAS-2 tool. The sensitivity and specificity of DSE varied greatly, the sensitivity range was 15 to 99%, and the specificity 83 to 99%. In a SROC model, the area under curve was 0.88 (SE =0.05) and index Q* value was 0.812 (SE =0.059). Overall, the pooled sensitivity of DSE was 15.27% (95% CI 11.14% to 20.20%) and the pooled specificity was 95.47 % (95% CI 92.64% to 97.44%). The pooled effect estimates were significantly heterogeneous (p