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November 3, 1999

Exercise Echocardiography vs Exercise SPECT Testing

Author Affiliations

Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999American Medical Association

JAMA. 1999;282(17):1622. doi:10.1001/jama.282.17.1622-JLT1103-2-3

To the Editor: Dr Fleischmann and colleagues1 provided a detailed summary of 2 commonly used noninvasive cardiac test modalities: exercise ECHO and exercise SPECT. We are concerned about the heterogeneity of the studies included in their meta-analysis.

Midgette et al2 state that when data from a number of reports are poorly correlated and heterogeneous, neither summary point estimates or summary receiver operating characteristic (SROC) curves are appropriate. Petitti3 has also reported that use of the fixed-effects model to create summary point estimates requires homogenous data. A test for homogeneity in the reports cited by Fleischmann et al reveals significant heterogeneity in both the exercise SPECT and exercise ECHO reports (χ2= 51.02 for SPECT, and 61.61 for ECHO, both P<.001). This leads us to question whether there might be significant underlying differences in the component reports, creating bias in the results.

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