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

Abstract

PURPOSE:

We 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).

METHODS:

We 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.

RESULTS:

CD 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: χ(2) = 7.59, P = .0059 for STPD and χ(2) = 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 (χ(2) = 4.92; P = .027) vs (χ(2) = 8.90; P = .003).

CONCLUSIONS:

Quantitative analysis is comparable to expert visual scoring in predicting CD in a case-controlled study.

• Authors: Yuan Xu, Ryo Nakazato, Sean Hayes, Rory Hachamovitch, Victor Y Cheng, Heidi Gransar, Romalisa Miranda-Peats, Mark Hyun, Leslee J Shaw, John Friedman, Guido Germano, Daniel S Berman, Piotr J Slomka
• Journal: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology (J Nucl Cardiol) Vol. 18 Issue 6 Pg. 1003-9; quiz 1010-4 (Dec 2011) ISSN: 1532-6551 [Electronic] United States
• PMID: 21932154 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Vasodilator Agents
• Adenosine

Topics

• Adenosine
• Aged
• California (epidemiology)
• Coronary Artery Disease (diagnostic imaging, mortality)
• Exercise Test (mortality)
• Female
• Humans
• Image Interpretation, Computer-Assisted (methods)
• Male
• Myocardial Perfusion Imaging (mortality)
• Prognosis
• Registries
• Reproducibility of Results
• Risk Assessment
• Risk Factors
• Sensitivity and Specificity
• Survival Analysis
• Survival Rate
• Tomography, Emission-Computed, Single-Photon (mortality, statistics & numerical data)
• Vasodilator Agents