Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
Circ J. 2011;75(10):2417-23. doi: 10.1253/circj.cj-11-0371. Epub 2011 Jul 28.
Myocardial perfusion imaging (MPI) has been used to estimate cardiac event risk. The aim of the present study is to achieve stable risk estimation based on perfusion scoring and a multi-center prognostic database.
Multivariate logistic regression analysis was performed to estimate cardiac event risk based on a J-ACCESS study. A stress-MPI was performed in 45 patients with coronary artery disease (CAD) and in 25 non-CAD patients. Perfusion defect scoring of summed stress score (SSS) was performed by 5 methods: (1) visual scoring; (2) automatic scoring of 3 short-axis and 1 vertical long-axis slices; (3) visual modification of Method 2; (4) automatic polar map scoring based on a Japanese multi-center database; and (5) visual modification of Method 4. Agreement of SSS between 2 observers was good (r=0.87-0.97). Agreement of estimated cardiac event risk between observers and among 5 methods was very good (r=0.99-1.00). Regarding diagnostic accuracy for CAD, Method 5 showed optimal diagnostic yields (sensitivity 84%, accuracy 77%).
Estimation of cardiac event risk in conjunction with polar map segmentation and common normal databases resulted in stable risk values, and might be used for risk stratification in patients suspected of having CAD.
心肌灌注成像（MPI）已被用于估计心脏事件风险。本研究旨在基于灌注评分和多中心预后数据库实现稳定的风险评估。
采用多变量逻辑回归分析方法，基于 J-ACCESS 研究来估计心脏事件风险。对 45 例冠心病（CAD）患者和 25 例非 CAD 患者进行应激 MPI。采用 5 种方法进行总和应激评分（SSS）的灌注缺损评分：（1）视觉评分；（2）3 个短轴和 1 个垂直长轴切片的自动评分；（3）方法 2 的视觉修正；（4）基于日本多中心数据库的自动极坐标图评分；以及（5）方法 4 的视觉修正。两名观察者之间的 SSS 一致性良好（r=0.87-0.97）。观察者之间和 5 种方法之间的估计心脏事件风险的一致性非常好（r=0.99-1.00）。关于 CAD 的诊断准确性，方法 5 显示出最佳的诊断效果（灵敏度 84%，准确性 77%）。
结合极坐标图分割和常见正常数据库来估计心脏事件风险，可产生稳定的风险值，可能用于疑似 CAD 患者的风险分层。
