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The Ability of Quantitative Data Evaluated by 99m Tc-MIBI Myocardial Perfusion Scintigraphy to Predict Coronary Artery Disease

Year 2021, Volume: 28 Issue: 1, 151 - 158, 11.03.2021
https://doi.org/10.17343/sdutfd.858572

Abstract

Objective:
Although the efficacy of the visual interpretation of 99mTc-MIBI myocardial perfusion imaging has been repeatedly confirmed in the diagnostic and prognostic evaluation of coronary artery disease (CAD), the efficacy of the automated quantitative evaluation dependent on computer programs is controversial. In our study, we compared automated quantitative data, such as the sum stress score (SSS) and the sum difference score (SDS), with coronary angiography results. We investigated the ability of SSS and SDS values to predict coronary artery disease.
Method:
SSS and SDS are measurements used in the global scoring of myocardial perfusion. While SSS indicates the degree of ischemia, SDS defines the reversibility degree of ischemia. In the global scoring of myocardial perfusion, when the SSS was 4 and above, MPI was evaluated as positive. In the coronary angiography, a stenosis value of >50% was evaluated as positive. We divided the SSS into three groups; mild (4-8), moderate (9-12), and advanced (>13) hypoperfusion. We divided the SDS into two groups as below and above 10%. We compared the subsequent quantitative data with the results of the three groups of coronary angiographies (<50%, 50-70%, and >70% stenosis).
Results:
A total of 104 patients who underwent angiography were included in the study. The accuracy in detecting positivity between the general quantitative MPI and angiography methods of the patients was calculated as 80.8%. The agreement value was found to be significant (Kappa=0.602; p<0.001). When the SSS groups and angiography groups were compared, the agreement value was found to be moderate but significant (Kendall's tau-b=0.373; p=0.014). Comparing the SDS groups and angiography groups, the agreement value was found to be significant at a low level (Kendall's tau-b=0.234; p = 0.014).
Conclusion:
Although general quantitative evaluation in MPI had a high predictive value of CAD, the CAD detection rates of detailed myocardial perfusion scoring (SSS, SDS) were not at a sufficient level. Therefore, we suggest that myocardial perfusion scoring alone will be insufficient in detecting CAD, and quantitative evaluation should be used as a complement to visual evaluation.

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References

  • 1) Goff Jr DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino Sr RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith Jr SC, Sorlie P, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/Ameri- can Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(25 Suppl. 2):S49–73.
  • 2) Monika Czaja, Zbigniew Wygoda, Agata Duszańska, Dominik Szczerba, Jan Głowacki, Mariusz Gąsior, Jarosław P. Wasilewski. Interpreting myocardial perfusion scintigraphy using single-photon emission computed tomography. Kardiochriugia i Torakochirurgia Polska 2017; 14 (3): 192-199
  • 3) William D. Leslie, Shawn A. Tully, Marina S. Yogendran, Linda M. Ward, Khaled A. Nour, and Colleen J. Metge. Prognostic Value of Automated Quantification of 99m Tc-Sestamibi Myocardial Perfusion Imaging. J Nucl Med. 2005;46:204-211.
  • 4) Yoda S, Nakanishi K, Tano A, Hori Y, Suzuki Y, Matsumoto N, Hirayama A. Validation of automated quantification of nuclear cardiology in Japanese patients using total perfusion deficits: comparison with visual assessment. J Cardiol 2014; 63: 350-357.
  • 5) Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes SW, Thom- son LE, Hachamovitch R, Shaw LJ, Slomka PJ, Yang LD, Germano G. Quantita- tive assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol 2009; 16: 45-53.
  • 6) Hachamovitch R, Rozanski A, Hayes SW, Thomson LE, Germano G, Fried- man JD, Cohen I, Berman DS. Predicting therapeutic benefit from myocardial revascularization procedures: are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary J Nucl Cardiol 2006; 13: 768-778.
  • 7) Weintraub WS, Karlsberg RP, Tcheng JE, Boris JR, Buxton AE, Dove JT, et al. ACCF/AHA 2011 key data elements and definitions of a base cardiovascular vocabulary for electronic health records: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards. J Am Coll Cardiol. 2011;58(2):202–222. 
  • 8) Patel MR, Bailey SR, Bonow RO, Chambers CE, Chan PS, Dehmer GJ, et al. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation. Appropriate use criteria Tak Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery. J Am Coll Cardiol. 2012;59(22):1995–2027. 
  • 9) Hendel RC, Budoff MJ, Cardella JF, Chambers CE, Dent JM, Fitzgerald DM, et al. ACC/ACR/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR/SIR 2008 key data elements and definitions for cardiac imaging: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Cardiac Imaging) J Am Coll Cardiol. 2009;53(1):91–124. 
  • 10) Fatma Aboul-Enein, Majed O. Aljuaid, Hail T. Alharthi, Abdulkarim M. Almudhhi, Mohammad A. Alzahrani. Hindawi Publishing Corporation Cardiology Research and Practice Volume 2016, Article ID 9847575, 6 pages http://dx.doi.org/10.1155/2016/9847575
  • 11) Shelley S, Indirani M, Sathyamurthy I, Subramanian K, Priti N, Harshad K, et al. Correlation of myocardial perfusion SPECT with invasive and computed tomography coronary angiogram. Indian Heart J. 2012;64(1):43–9. doi: 10.1016/S0019-4832(12)60010-8. [PubMed: 22572425].
  • 12) Fard-Esfahani A, Fallahi B, Saghari M, Eftekhari M, Beiki D. Myocar- dial perfusion scan accuracy in detection of coronary artery disease- comparison with exercise stress test [In Persian]. Iran J Nucl Med. 
2007;15:16–23.
  • 13) Fiechter M, Ghadri JR, Kuest SM, Pazhenkottil AP, Wolfrum M, Nk- oulou RN, et al. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first vali- dation versus invasive coronary angiography. Eur J Nucl Med Mol Imaging. 2011;38(11):2025–30. doi: 10.1007/s00259-011-1877-y. [PubMed: 21761267].
  • 14) Berman DS, Kang X, Van Train KF, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1998;32:1987–1995.

99mTc-MIBI Miyokard Perfüzyon Sintigrafisi ile Değerlendirilen Kantitatif Verilerin, Koroner Arter Hastalığını Öngörme Kabiliyeti

Year 2021, Volume: 28 Issue: 1, 151 - 158, 11.03.2021
https://doi.org/10.17343/sdutfd.858572

Abstract

Amaç:
99mTc-MIBI miyokardiyal perfüzyon görüntülemenin, visual yorumunun etkinliği, koroner arter hastalığının (KAH) tanısal ve prognostik değerlendirmesinde defalarca doğrulanmasına rağmen, bilgisayar programlarına bağımlı otomatik kantitatif değerlendirmenin etkinliği tartışma konusudur. Biz çalışmamızda, sum stress score (SSS) ve sum difference score (SDS) gibi otomatik kantitatif verileri, koroner anjiyografi sonuçları ile karşılaştırdık. SSS ve SDS değerlerinin, koroner arter hastalığını öngörme kabiliyetini araştırdık.
Yöntem:
SSS ve SDS, myocardial perfüzyonun global skorlamasında kullanılan ölçümlerdir. SSS’u iskeminin derecesini gösterirken, SDS iskeminin geri döndürülebilir olma derecesini tanımlar. Myokardiyal perfüzyonun global skorlamasında, SSS’u 4 ve üzerinde ise MPS pozitif olarak değerlendirildi. Koroner anjiografide ise >%50 üzerinde darlık pozitif olarak değerlendirildi. SSS’nu hafif (4-8), orta (9-12) ve ileri (>13) düzeyde hipoperfüzyon olmak üzere 3 gruba ayırdık. SDS’nu %10 un altı ve üstü olmak üzere 2 gruba ayırdık. Bu kantitatif verileri, 3 grup koroner anjiyografi sonuçlarıyla karşılaştırdık (<%50, %50-70, >%70 darlık).
Bulgular:
Çalışmaya toplam 104 anjiyo uygulaması yapılan hasta dahil edildi. Hastaların genel kantitatif MPS ve anjiyografi yöntemleri arasındaki pozitiflik tespitindeki doğruluk %80,8 olarak hesaplandı. Uyuşum değeri anlamlı bulundu (Kappa=0,602; p<0,001). SSS grupları ile anjiyografi grupları karşılaştırıldığında, uyuşum değeri orta düzeyde fakat anlamlı bulundu (Kendall’s tau-b=0,373; p=0,014). SDS grupları ile anjiyografi grupları karşılaştırıldığında, uyuşum değeri düşük düzeyde anlamlı bulundu (Kendall’s tau-b=0,234; p=0,014).
Sonuç:
MPS’de genel kantitatif değerlendirmenin, KAH’nı tahmin etme değeri yüksek olarak bulunmakla birlikte ayrıntılı myokardiyal perfüzyon skorlamanın (SSS, SDS), KAH’lığını tespit oranları yeterli düzeyde değildi. Dolayısıyla sadece myokardiyal perfüzyon skorlamanın, KAH’nı tespit etmede yetersiz kalacağını, kantitatif değerlendirmenin, visual değerlendirmeye tamamlayıcı olarak kullanılması gerektiğini öneriyoruz.

Project Number

-

References

  • 1) Goff Jr DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino Sr RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith Jr SC, Sorlie P, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/Ameri- can Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(25 Suppl. 2):S49–73.
  • 2) Monika Czaja, Zbigniew Wygoda, Agata Duszańska, Dominik Szczerba, Jan Głowacki, Mariusz Gąsior, Jarosław P. Wasilewski. Interpreting myocardial perfusion scintigraphy using single-photon emission computed tomography. Kardiochriugia i Torakochirurgia Polska 2017; 14 (3): 192-199
  • 3) William D. Leslie, Shawn A. Tully, Marina S. Yogendran, Linda M. Ward, Khaled A. Nour, and Colleen J. Metge. Prognostic Value of Automated Quantification of 99m Tc-Sestamibi Myocardial Perfusion Imaging. J Nucl Med. 2005;46:204-211.
  • 4) Yoda S, Nakanishi K, Tano A, Hori Y, Suzuki Y, Matsumoto N, Hirayama A. Validation of automated quantification of nuclear cardiology in Japanese patients using total perfusion deficits: comparison with visual assessment. J Cardiol 2014; 63: 350-357.
  • 5) Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes SW, Thom- son LE, Hachamovitch R, Shaw LJ, Slomka PJ, Yang LD, Germano G. Quantita- tive assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol 2009; 16: 45-53.
  • 6) Hachamovitch R, Rozanski A, Hayes SW, Thomson LE, Germano G, Fried- man JD, Cohen I, Berman DS. Predicting therapeutic benefit from myocardial revascularization procedures: are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary J Nucl Cardiol 2006; 13: 768-778.
  • 7) Weintraub WS, Karlsberg RP, Tcheng JE, Boris JR, Buxton AE, Dove JT, et al. ACCF/AHA 2011 key data elements and definitions of a base cardiovascular vocabulary for electronic health records: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards. J Am Coll Cardiol. 2011;58(2):202–222. 
  • 8) Patel MR, Bailey SR, Bonow RO, Chambers CE, Chan PS, Dehmer GJ, et al. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation. Appropriate use criteria Tak Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery. J Am Coll Cardiol. 2012;59(22):1995–2027. 
  • 9) Hendel RC, Budoff MJ, Cardella JF, Chambers CE, Dent JM, Fitzgerald DM, et al. ACC/ACR/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR/SIR 2008 key data elements and definitions for cardiac imaging: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Cardiac Imaging) J Am Coll Cardiol. 2009;53(1):91–124. 
  • 10) Fatma Aboul-Enein, Majed O. Aljuaid, Hail T. Alharthi, Abdulkarim M. Almudhhi, Mohammad A. Alzahrani. Hindawi Publishing Corporation Cardiology Research and Practice Volume 2016, Article ID 9847575, 6 pages http://dx.doi.org/10.1155/2016/9847575
  • 11) Shelley S, Indirani M, Sathyamurthy I, Subramanian K, Priti N, Harshad K, et al. Correlation of myocardial perfusion SPECT with invasive and computed tomography coronary angiogram. Indian Heart J. 2012;64(1):43–9. doi: 10.1016/S0019-4832(12)60010-8. [PubMed: 22572425].
  • 12) Fard-Esfahani A, Fallahi B, Saghari M, Eftekhari M, Beiki D. Myocar- dial perfusion scan accuracy in detection of coronary artery disease- comparison with exercise stress test [In Persian]. Iran J Nucl Med. 
2007;15:16–23.
  • 13) Fiechter M, Ghadri JR, Kuest SM, Pazhenkottil AP, Wolfrum M, Nk- oulou RN, et al. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first vali- dation versus invasive coronary angiography. Eur J Nucl Med Mol Imaging. 2011;38(11):2025–30. doi: 10.1007/s00259-011-1877-y. [PubMed: 21761267].
  • 14) Berman DS, Kang X, Van Train KF, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1998;32:1987–1995.
There are 14 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Mehmet Erdoğan 0000-0001-7724-778X

Bayram Ali Uysal 0000-0002-8800-0835

Mustafa Karabacak 0000-0001-6879-5522

Mevlüt Serdar Kuyumcu 0000-0003-1934-5773

Mustafa Avcı 0000-0001-9730-2846

Samet Yağcı 0000-0001-6433-5051

Adnan Karaıbrahımoglu 0000-0002-8277-0281

Sevim Süreyya Şengül 0000-0002-4009-369X

Project Number -
Publication Date March 11, 2021
Submission Date January 11, 2021
Acceptance Date February 22, 2021
Published in Issue Year 2021 Volume: 28 Issue: 1

Cite

Vancouver Erdoğan M, Uysal BA, Karabacak M, Kuyumcu MS, Avcı M, Yağcı S, Karaıbrahımoglu A, Şengül SS. The Ability of Quantitative Data Evaluated by 99m Tc-MIBI Myocardial Perfusion Scintigraphy to Predict Coronary Artery Disease. Med J SDU. 2021;28(1):151-8.

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