Prognostic value of automated vs visual analysis for adenosine stress myocardial perfusion SPECT in patients without prior coronary artery disease: A case-control study

PurposeWe aimed to evaluate the prognostic value of automated quantitative hypoperfusion parameters derived from adenosine stress myocardial perfusion SPECT (MPS) for predicting sudden or cardiac death (CD) in case-controlled patients with suspected coronary artery disease (CAD).MethodsWe considered patients with available adenosine stress Tc-99m sestamibi MPS scans and follow-up information. 81 CD patients from a registry of 428 patients documented by the National Death Index were directly matched in a retrospective case-control design to patients without CD by key clinical parameters (age by deciles, gender, no early revascularization, pre-test likelihood categories, diabetes, and chest pain symptoms). Multivariable analysis of stress MPS total perfusion deficit (STPD) and major clinical confounders were used as predictors of CD. Visual 17-segment summed stress segmental scores (VSSS) obtained by an expert reader, were compared to STPD.ResultsCD patients had higher stress hypoperfusion measures compared to controls [STPD: 7.0% vs 3.6% (P < .05), VSSS: 5.3 vs 2.1 (P < .05)]. By univariate analysis, STPD and VSSS have similar predictive power (the areas under receiver operator characteristics curves: STPD = 0.64, VSSS = 0.63; Kaplan-Meier models: χ2 = 7.59, P = .0059 for STPD and χ2 = 11.10, P = .0009 for VSSS). The multiple Cox proportional hazards regression models with continuous perfusion measures showed that STPD had similar power to normalized VSSS as a predictor for CD (χ2 = 4.92; P = .027) vs (χ2 = 8.90; P = .003).ConclusionsQuantitative analysis is comparable to expert visual scoring in predicting CD in a case-controlled study.

[1]  David R. Cox,et al.  Regression models and life tables (with discussion , 1972 .

[2]  D. Berman,et al.  Anatomic and functional assessment of coronary artery disease: convergence of 2 aims in a single setting. , 2009, Circulation. Cardiovascular imaging.

[3]  Gregg W Stone,et al.  Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease. , 2010, The New England journal of medicine.

[4]  Leif E. Peterson,et al.  The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk. , 2009, Journal of the American College of Cardiology.

[5]  A. Matamoros.  Novel Techniques for Imaging the Heart: Cardiac MR and CT , 2009, Journal of Nuclear Medicine.

[6]  D. Berman,et al.  Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. , 1998, Circulation.

[7]  Piotr J. Slomka,et al.  Automatic and visual reproducibility of perfusion and function measures for myocardial perfusion SPECT , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[8]  R. Gibbons,et al.  The prognostic value of pharmacologic stress myocardial perfusion imaging in patients with permanent pacemakers , 2005, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[9]  T. Nishimura,et al.  Relation between prognosis and myocardial perfusion imaging from the difference of end-point criterion for exercise stress testing: a sub-analysis of the J-ACCESS study. , 2010, Journal of cardiology.

[10]  G. Diamond,et al.  Computer-assisted diagnosis in the noninvasive evaluation of patients with suspected coronary artery disease. , 1983, Journal of the American College of Cardiology.

[11]  Amit Ramesh,et al.  Automated Quality Control for Segmentation of Myocardial Perfusion SPECT , 2009, Journal of Nuclear Medicine.

[12]  R. Gibbons,et al.  Prognostic value of vasodilator myocardial perfusion imaging in patients with left bundle-branch block. , 1998, Circulation.

[13]  D. Berman,et al.  Incremental prognostic value of adenosine myocardial perfusion single-photon emission computed tomography in women with suspected coronary artery disease. , 1998, The American journal of cardiology.

[14]  D. Berman,et al.  Comparison of the Short‐Term Survival Benefit Associated With Revascularization Compared With Medical Therapy in Patients With No Prior Coronary Artery Disease Undergoing Stress Myocardial Perfusion Single Photon Emission Computed Tomography , 2003, Circulation.

[15]  G. Beller,et al.  Critical Review of Imaging Approaches for the Diagnosis and Prognosis of CAD , 2009 .

[16]  D. Berman,et al.  Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease. , 1987, Journal of the American College of Cardiology.

[17]  H. Akaike.  A new look at the statistical model identification , 1974 .

[18]  D. Berman,et al.  Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: a clinical validation study. , 1993, Journal of the American College of Cardiology.

[19]  D. Berman,et al.  Prognostic Implications of Myocardial Perfusion Single-Photon Emission Computed Tomography in the Elderly , 2009, Circulation.

[20]  Regina M. Hardison,et al.  The Bypass Angioplasty Revascularization Investigation 2 Diabetes Randomized Trial of Different Treatment Strategies in Type 2 Diabetes Mellitus With Stable Ischemic Heart Disease: Impact of Treatment Strategy on Cardiac Mortality and Myocardial Infarction , 2009, Circulation.

[21]  D. Berman,et al.  Prognosis by coronary computed tomographic angiography: matched comparison with myocardial perfusion single-photon emission computed tomography. , 2008, Journal of cardiovascular computed tomography.

[22]  Guido Germano,et al.  Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis , 2009, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[23]  D. Berman,et al.  A prognostic score for prediction of cardiac mortality risk after adenosine stress myocardial perfusion scintigraphy. , 2005, Journal of the American College of Cardiology.

[24]  D. Berman,et al.  Incremental prognostic value of adenosine stress myocardial perfusion single-photon emission computed tomography and impact on subsequent management in patients with or suspected of having myocardial ischemia. , 1997, The American journal of cardiology.

[25]  Guido Germano,et al.  Combined supine and prone quantitative myocardial perfusion SPECT: method development and clinical validation in patients with no known coronary artery disease. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[26]  D. Berman,et al.  Multicenter trial validation for quantitative analysis of same-day rest-stress technetium-99m-sestamibi myocardial tomograms. , 1994, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[27]  D. Berman,et al.  Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[28]  D. Berman,et al.  Clinical applications of exercise nuclear cardiology studies in the era of healthcare reform. , 1995, The American journal of cardiology.

[29]  D. Berman,et al.  Automated quantification of myocardial perfusion SPECT using simplified normal limits , 2004, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[30]  W. Leslie,et al.  Prognostic value of automated quantification of 99mTc-sestamibi myocardial perfusion imaging. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[31]  L. Husmann,et al.  Improved Outcome Prediction by SPECT Myocardial Perfusion Imaging After CT Attenuation Correction , 2011, The Journal of Nuclear Medicine.