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  • Title: Prognostic value of automated vs visual analysis for adenosine stress myocardial perfusion SPECT in patients without prior coronary artery disease: a case-control study.
    Author: Xu Y, Nakazato R, Hayes S, Hachamovitch R, Cheng VY, Gransar H, Miranda-Peats R, Hyun M, Shaw LJ, Friedman J, Germano G, Berman DS, Slomka PJ.
    Journal: J Nucl Cardiol; 2011 Dec; 18(6):1003-9; quiz 1010-4. PubMed ID: 21932154.
    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.
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