Cardiac Testing for Coronary Artery Disease in Potential Kidney Transplant Recipients: A Systematic Review of Test Accuracy Studies  Louis W. Wang, MM(ClinEpi)(Hons), Magid A. Fahim, MD, Andrew Hayen, PhD, Ruth L. Mitchell, MA(Inf), Stephen W. Lord, DM, Laura A. Baines, MD, Jonathan C. Craig, PhD, Angela C. Webster, PhD  American Journal of Kidney Diseases  Volume 57, Issue 3, Pages 476-487 (March 2011) DOI: 10.1053/j.ajkd.2010.11.018 Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Flow of studies identified in the literature search for systematic review of testing for coronary artery disease in potential kidney transplant recipients. *Some studies investigate more than 1 test and thus contribute to more than 1 test comparison. Abbreviation: CT, computed tomography. American Journal of Kidney Diseases 2011 57, 476-487DOI: (10.1053/j.ajkd.2010.11.018) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Method design and reporting quality of studies included in meta-analysis according to risk of bias in quality domains assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Incorporation avoided: the reference standard was independent of the index test. American Journal of Kidney Diseases 2011 57, 476-487DOI: (10.1053/j.ajkd.2010.11.018) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Accuracy of tests for coronary artery disease versus coronary angiography (forest plot). Abbreviations: FN, false negative; FP, false positive; NS, not stated; TN, total negative; TP, total positive. American Journal of Kidney Diseases 2011 57, 476-487DOI: (10.1053/j.ajkd.2010.11.018) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 Summary receiver operator characteristic (ROC) curve plot of sensitivity versus specificity for performance of different tests versus coronary angiography. Each symbol represents a study, with the height and width of each symbol proportional to the inverse standard error of the sensitivity and specificity, respectively. Curves represent summary ROC curves for myocardial perfusion scintigraphy and dobutamine stress echocardiography. Black circles represent the summary estimate of test performance, and the zone outline surrounding it represents the 95% confidence region of this summary estimate. The lines connecting paired myocardial perfusion scintigraphy and dobutamine stress echocardiography studies denote studies that investigated the accuracy of myocardial perfusion scintigraphy and dobutamine stress echocardiography in the same study population (direct comparison). American Journal of Kidney Diseases 2011 57, 476-487DOI: (10.1053/j.ajkd.2010.11.018) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

Figure 5 Posttest probabilities for significant coronary artery disease in potential kidney transplant recipients. Based on positive and negative likelihood ratios calculated from the systematic review in studies that avoided partial verification and used a reference standard threshold of ≥70% stenosis. Dobutamine stress echocardiography (DSE) had a positive likelihood ratio of 6.21 (2.88-13.40) and negative likelihood ratio of 0.25 (0.13-0.51). Myocardial perfusion scintigraphy (MPS) had a positive likelihood ratio of 3.32 (1.29-8.59) and negative likelihood ratio of 0.41 (0.19-0.89). American Journal of Kidney Diseases 2011 57, 476-487DOI: (10.1053/j.ajkd.2010.11.018) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions