Diagnostic performance of prone-only myocardial perfusion imaging versus coronary angiography in the detection of coronary artery disease: A systematic review and meta-analysis

Study design: Although prone position is considered as a complementary protocol in myocardial perfusion imaging (MPI), there is no consensus on its capability to find coronary artery disease (CAD), independently. The primary aim of this review was to report pooled sensitivity and specificity for prone position MPI in detection of CAD. In addition, the results were compared to the supine position's performance.

Methods: Electronic bibliographic databases, The Cochrane Library, Web of Science (Science and Social Science Citation Index), Scopus, PubMed, and EMBASE until the end of June 2020 were searched. Studies were included based on the inclusion criteria of (1) evaluated the prone position MPI, (2) defined CAD with coronary angiography (CAG), using the threshold of ≥ 50% stenosis, (3) Adequate data were provided to extract the diagnostic performance. QUADAS-2 tool was utilized to assess the quality of included studies. Pooled sensitivity and specificity were calculated for prone and supine positions, separately. The hierarchical summary ROC curves were also drawn.

Results: Ten individual studies with the data of the 1490 patients for the prone position and 1138 patients for the supine position were included. Pooled sensitivity and specificity for the prone position were 83% and 79%, respectively. These results were calculated for the supine position as the sensitivity of 86% and specificity of 67%. The pooled sensitivity and specificity of the prone position in detecting the right coronary artery territory defects were 70% and 84%, in turn.

Conclusion: In the suspicion for the CAD, prone position with comparable sensitivity and higher specificity can be an acceptable alternative to the supine position as the standard method. Also, in the cases of possible defects in the RCA territory, prone position showed to be a superior standard.