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

Francesco Nudi, Annamaria Pinto, Enrica Procaccini, Giandomenico Neri, Maurizio Vetere, Fabrizio Tomai, Achille Gaspardone, Giuseppe Biondi-Zoccai, Orazio Schillaci

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)807-818
Number of pages12
JournalJournal of Nuclear Cardiology
Volume21
Issue number4
DOIs
Publication statusPublished - 2014

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Myocardial Perfusion Imaging
Perfusion Imaging
Ischemia
Myocardial Infarction
Workload
Myocardium
Necrosis

Keywords

  • maximal ischemia score
  • Myocardial ischemia
  • myocardial perfusion imaging
  • myocardial perfusion scintigraphy
  • segmentation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

A novel clinically relevant segmentation method and corresponding maximal ischemia score to risk-stratify patients undergoing myocardial perfusion scintigraphy. / Nudi, Francesco; Pinto, Annamaria; Procaccini, Enrica; Neri, Giandomenico; Vetere, Maurizio; Tomai, Fabrizio; Gaspardone, Achille; Biondi-Zoccai, Giuseppe; Schillaci, Orazio.

In: Journal of Nuclear Cardiology, Vol. 21, No. 4, 2014, p. 807-818.

Research output: Contribution to journalArticle

Nudi, Francesco ; Pinto, Annamaria ; Procaccini, Enrica ; Neri, Giandomenico ; Vetere, Maurizio ; Tomai, Fabrizio ; Gaspardone, Achille ; Biondi-Zoccai, Giuseppe ; Schillaci, Orazio. / A novel clinically relevant segmentation method and corresponding maximal ischemia score to risk-stratify patients undergoing myocardial perfusion scintigraphy. In: Journal of Nuclear Cardiology. 2014 ; Vol. 21, No. 4. pp. 807-818.
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AU - Nudi, Francesco

AU - Pinto, Annamaria

AU - Procaccini, Enrica

AU - Neri, Giandomenico

AU - Vetere, Maurizio

AU - Tomai, Fabrizio

AU - Gaspardone, Achille

AU - Biondi-Zoccai, Giuseppe

AU - Schillaci, Orazio

PY - 2014

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N2 - 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.

AB - 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.

KW - maximal ischemia score

KW - Myocardial ischemia

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KW - segmentation

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