Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation

Daniel S. Berman, Aiden Abidov, Xingping Kang, Sean W. Hayes, John D. Friedman, Maria G. Sciammarella, Ishac Cohen, James Gerlach, Parker B. Waechter, Guido Germano, Rory Hachamovitch

Research output: Contribution to journalArticle

183 Citations (Scopus)

Abstract

Background. Recently, a 17-segment model of the left ventricle has been recommended as an optimally weighted approach for interpreting myocardial perfusion single photon emission computed tomography (SPECT). Methods to convert databases from previous 20- to new 17-segment data and criteria for abnormality for the 17-segment scores are needed. Methods and Results. Initially, for derivation of the conversion algorithm, 65 patients were studied (algorithm population) (pilot group, n = 28; validation group, n = 37). Three conversion algorithms were derived: algorithm 1, which used mid, distal, and apical scores; algorithm 2, which used distal and apical scores alone; and algorithm 3, which used maximal scores of the distal septal, lateral, and apical segments in the 20-segment model for 3 corresponding segments of the 17-segment model. The prognosis population comprised 16,020 consecutive patients (mean age, 65 ± 12 years; 41% women) who had exercise or vasodilator stress technetium 99m sestamibi myocardial perfusion SPECT and were followed up for 2.1 ± 0.8 years. In this population, 17-segment scores were derived from 20-segment scores by use of algorithm 2, which demonstrated the best agreement with expert 17-segment reading in the algorithm population. The prognostic value of the 20- and 17-segment scores was compared by converting the respective summed scores into percent myocardium abnormal. Conversion algorithm 2 was found to be highly concordant with expert visual analysis by the 17-segment model (r = 0.982; κ = 0.866) in the algorithm population. In the prognosis population, 456 cardiac deaths occurred during follow-up. When the conversion algorithm was applied, extent and severity of perfusion defects were nearly identical by 20- and derived 17-segment scores. The receiver operating characteristic curve areas by 20- and 17-segment perfusion scores were identical for predicting cardiac death (both 0.77 ± 0.02, P = not significant). The optimal prognostic cutoff value for either 20- or derived 17-segment models was confirmed to be 5% myocardium abnormal, corresponding to a summed stress score greater than 3. Of note, the 17-segment model demonstrated a trend toward fewer mildly abnormal scans and more normal and severely abnormal scans. Conclusion. An algorithm for conversion of 20-segment perfusion scores to 17-segment scores has been developed that is highly concordant with expert visual analysis by the 17-segment model and provides nearly identical prognostic information. This conversion model may provide a mechanism for comparison of studies analyzed by the 17-segment system with previous studies analyzed by the 20-segment approach.

Original languageEnglish (US)
Pages (from-to)414-423
Number of pages10
JournalJournal of Nuclear Cardiology
Volume11
Issue number4
DOIs
StatePublished - Jul 2004
Externally publishedYes

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Single-Photon Emission-Computed Tomography
Perfusion
Population
Myocardium
Technetium Tc 99m Sestamibi
Vasodilator Agents
Population Groups
ROC Curve
Heart Ventricles
Reading
Databases
Exercise

Keywords

  • Cardiac death
  • Myocardial perfusion
  • Single photon emission computed tomography
  • Summed stress score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. / Berman, Daniel S.; Abidov, Aiden; Kang, Xingping; Hayes, Sean W.; Friedman, John D.; Sciammarella, Maria G.; Cohen, Ishac; Gerlach, James; Waechter, Parker B.; Germano, Guido; Hachamovitch, Rory.

In: Journal of Nuclear Cardiology, Vol. 11, No. 4, 07.2004, p. 414-423.

Research output: Contribution to journalArticle

Berman, DS, Abidov, A, Kang, X, Hayes, SW, Friedman, JD, Sciammarella, MG, Cohen, I, Gerlach, J, Waechter, PB, Germano, G & Hachamovitch, R 2004, 'Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation', Journal of Nuclear Cardiology, vol. 11, no. 4, pp. 414-423. https://doi.org/10.1016/j.nuclcard.2004.03.033
Berman, Daniel S. ; Abidov, Aiden ; Kang, Xingping ; Hayes, Sean W. ; Friedman, John D. ; Sciammarella, Maria G. ; Cohen, Ishac ; Gerlach, James ; Waechter, Parker B. ; Germano, Guido ; Hachamovitch, Rory. / Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. In: Journal of Nuclear Cardiology. 2004 ; Vol. 11, No. 4. pp. 414-423.
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abstract = "Background. Recently, a 17-segment model of the left ventricle has been recommended as an optimally weighted approach for interpreting myocardial perfusion single photon emission computed tomography (SPECT). Methods to convert databases from previous 20- to new 17-segment data and criteria for abnormality for the 17-segment scores are needed. Methods and Results. Initially, for derivation of the conversion algorithm, 65 patients were studied (algorithm population) (pilot group, n = 28; validation group, n = 37). Three conversion algorithms were derived: algorithm 1, which used mid, distal, and apical scores; algorithm 2, which used distal and apical scores alone; and algorithm 3, which used maximal scores of the distal septal, lateral, and apical segments in the 20-segment model for 3 corresponding segments of the 17-segment model. The prognosis population comprised 16,020 consecutive patients (mean age, 65 ± 12 years; 41{\%} women) who had exercise or vasodilator stress technetium 99m sestamibi myocardial perfusion SPECT and were followed up for 2.1 ± 0.8 years. In this population, 17-segment scores were derived from 20-segment scores by use of algorithm 2, which demonstrated the best agreement with expert 17-segment reading in the algorithm population. The prognostic value of the 20- and 17-segment scores was compared by converting the respective summed scores into percent myocardium abnormal. Conversion algorithm 2 was found to be highly concordant with expert visual analysis by the 17-segment model (r = 0.982; κ = 0.866) in the algorithm population. In the prognosis population, 456 cardiac deaths occurred during follow-up. When the conversion algorithm was applied, extent and severity of perfusion defects were nearly identical by 20- and derived 17-segment scores. The receiver operating characteristic curve areas by 20- and 17-segment perfusion scores were identical for predicting cardiac death (both 0.77 ± 0.02, P = not significant). The optimal prognostic cutoff value for either 20- or derived 17-segment models was confirmed to be 5{\%} myocardium abnormal, corresponding to a summed stress score greater than 3. Of note, the 17-segment model demonstrated a trend toward fewer mildly abnormal scans and more normal and severely abnormal scans. Conclusion. An algorithm for conversion of 20-segment perfusion scores to 17-segment scores has been developed that is highly concordant with expert visual analysis by the 17-segment model and provides nearly identical prognostic information. This conversion model may provide a mechanism for comparison of studies analyzed by the 17-segment system with previous studies analyzed by the 20-segment approach.",
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AU - Berman, Daniel S.

AU - Abidov, Aiden

AU - Kang, Xingping

AU - Hayes, Sean W.

AU - Friedman, John D.

AU - Sciammarella, Maria G.

AU - Cohen, Ishac

AU - Gerlach, James

AU - Waechter, Parker B.

AU - Germano, Guido

AU - Hachamovitch, Rory

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N2 - Background. Recently, a 17-segment model of the left ventricle has been recommended as an optimally weighted approach for interpreting myocardial perfusion single photon emission computed tomography (SPECT). Methods to convert databases from previous 20- to new 17-segment data and criteria for abnormality for the 17-segment scores are needed. Methods and Results. Initially, for derivation of the conversion algorithm, 65 patients were studied (algorithm population) (pilot group, n = 28; validation group, n = 37). Three conversion algorithms were derived: algorithm 1, which used mid, distal, and apical scores; algorithm 2, which used distal and apical scores alone; and algorithm 3, which used maximal scores of the distal septal, lateral, and apical segments in the 20-segment model for 3 corresponding segments of the 17-segment model. The prognosis population comprised 16,020 consecutive patients (mean age, 65 ± 12 years; 41% women) who had exercise or vasodilator stress technetium 99m sestamibi myocardial perfusion SPECT and were followed up for 2.1 ± 0.8 years. In this population, 17-segment scores were derived from 20-segment scores by use of algorithm 2, which demonstrated the best agreement with expert 17-segment reading in the algorithm population. The prognostic value of the 20- and 17-segment scores was compared by converting the respective summed scores into percent myocardium abnormal. Conversion algorithm 2 was found to be highly concordant with expert visual analysis by the 17-segment model (r = 0.982; κ = 0.866) in the algorithm population. In the prognosis population, 456 cardiac deaths occurred during follow-up. When the conversion algorithm was applied, extent and severity of perfusion defects were nearly identical by 20- and derived 17-segment scores. The receiver operating characteristic curve areas by 20- and 17-segment perfusion scores were identical for predicting cardiac death (both 0.77 ± 0.02, P = not significant). The optimal prognostic cutoff value for either 20- or derived 17-segment models was confirmed to be 5% myocardium abnormal, corresponding to a summed stress score greater than 3. Of note, the 17-segment model demonstrated a trend toward fewer mildly abnormal scans and more normal and severely abnormal scans. Conclusion. An algorithm for conversion of 20-segment perfusion scores to 17-segment scores has been developed that is highly concordant with expert visual analysis by the 17-segment model and provides nearly identical prognostic information. This conversion model may provide a mechanism for comparison of studies analyzed by the 17-segment system with previous studies analyzed by the 20-segment approach.

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KW - Cardiac death

KW - Myocardial perfusion

KW - Single photon emission computed tomography

KW - Summed stress score

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