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A novel clinically relevant segmentation method and corresponding maximal ischemia score to risk-stratify patients undergoing myocardial perfusion scintigraphy

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Myocardial perfusion scintigraphy (MPS) represents a key prognostic tool, but its predictive yield is far from perfect. We developed a novel clinically relevant segmentation method and a corresponding maximal ischemia score (MIS) in order to risk-stratify patients undergoing MPS.

Methods

Patients referred for MPS were identified, excluding those with evidence of myocardial necrosis or prior revascularization. A seven-region segmentation approach was adopted for left ventricular myocardium, with a corresponding MIS distinguishing five groups (no, minimal, mild, moderate, or severe ischemia). The association between MIS and clinical events was assessed at 1 year and at long-term follow-up.

Results

A total of 8,714 patients were included, with a clinical follow-up of 31 ± 20 months. Unadjusted analyses showed that subjects with a higher MIS were significantly different for several baseline and test data, being older, having lower ejection fraction, and achieving lower workloads (P < .05 for all). Adverse outcomes were also more frequent in patients with higher levels of ischemia, including cardiac death, myocardial infarction (MI), and their composites (P < .05 for all). Differences in adverse events remained significant even after extensive multivariable adjustment (hazard ratio for each MIS increment = 1.57 [1.29-1.90], P < .001 for cardiac death; 1.19 [1.04-1.36], P = .013 for MI; 1.23 [1.09-1.39], P = .001 for cardiac death/MI).

Conclusions

Our novel segmentation method and corresponding MIS efficiently yield satisfactory prognostic information.

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Disclosures

All authors have no funding or conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy

    Francesco Nudi MD, Annamaria Pinto MD, Enrica Procaccini MD, Giandomenico Neri MD & Maurizio Vetere BSc

  2. ETISAN, Rome, Italy

    Francesco Nudi MD

  3. Division of Cardiology, European Hospital, Rome, Italy

    Fabrizio Tomai MD

  4. Division of Cardiology, S. Eugenio Hospital, Rome, Italy

    Achille Gaspardone MD

  5. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Giuseppe Biondi-Zoccai MD

  6. Department of Nuclear Medicine, Tor Vergata University of Rome, Rome, Italy

    Orazio Schillaci MD

Authors
  1. Francesco Nudi MD
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  2. Annamaria Pinto MD
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  3. Enrica Procaccini MD
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  4. Giandomenico Neri MD
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  5. Maurizio Vetere BSc
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  6. Fabrizio Tomai MD
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  7. Achille Gaspardone MD
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  8. Giuseppe Biondi-Zoccai MD
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  9. Orazio Schillaci MD
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Corresponding author

Correspondence to Francesco Nudi MD.

Additional information

See related editorial, doi:10.1007/s12350-014-9929-x.

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Nudi, F., Pinto, A., Procaccini, E. et al. A novel clinically relevant segmentation method and corresponding maximal ischemia score to risk-stratify patients undergoing myocardial perfusion scintigraphy. J. Nucl. Cardiol. 21, 807–818 (2014). https://doi.org/10.1007/s12350-014-9877-5

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  • DOI: https://doi.org/10.1007/s12350-014-9877-5

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