OBJECTIVES This study compared the ability of automated myocardial perfusion imaging analysis to predict major adverse cardiac events (MACE) to that of visual analysis. BACKGROUND Quantitative analysis has not been compared with clinical visual analysis in prognostic studies. METHODS A total of 19,495 patients from the multicenter REFINE SPECT (REgistry of Fast Myocardial Perfusion Imaging with NExt generation SPECT) study (64 ± 12 years of age, 56% males) undergoing stress Tc-99m-labeled single-photon emission computed tomography (SPECT) myocardial perfusion imaging were followed for 4.5 ± 1.7 years for MACE. Perfusion abnormalities were assessed visually and categorized as normal, probably normal, equivocal, or abnormal. Stress total perfusion deficit (TPD), quantified automatically, was categorized as TPD = 0%, TPD >0% to <1%, ≤1% to <3%, ≤3% to <5%, ≤5% to ≤10%, or TPD >10%. MACE consisted of death, nonfatal myocardial infarction, unstable angina, or late revascularization (>90 days). Kaplan-Meier and Cox proportional hazards analyses were performed to test the performance of visual and quantitative assessments in predicting MACE. RESULTS During follow-up examinations, 2,760 (14.2%) MACE occurred. MACE rates increased with worsening of visual assessments, that is, the rate for normal MACE was 2.0%, 3.2% for probably normal, 4.2% for equivocal, and 7.4% for abnormal (all p < 0.001). MACE rates increased with increasing stress TPD from 1.3% for the TPD category of 0% to 7.8% for the TPD category of >10% (p < 0.0001). The adjusted hazard ratio (HR) for MACE increased even in equivocal assessment (HR: 1.56; 95% confidence interval [CI]: 1.37 to 1.78) and in the TPD category of ≤3% to <5% (HR: 1.74; 95% CI: 1.41 to 2.14; all p < 0.001). The rate of MACE in patients visually assessed as normal still increased from 1.3% (TPD = 0%) to 3.4% (TPD ≥5%) (p < 0.0001). CONCLUSIONS Quantitative analysis allows precise granular risk stratification in comparison to visual reading, even for cases with normal clinical reading.

中文翻译：

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定量与视觉MPI对细微灌注缺陷的5年预后价值：来自REFINE SPECT的结果。

目的本研究比较了自动心肌灌注成像分析预测主要不良心脏事件（MACE）和视觉分析的能力。背景技术在预后研究中尚未将定量分析与临床视觉分析进行比较。方法来自多中心REFINE SPECT（采用NExt世代SPECT的快速心肌灌注成像技术）研究的19,495名患者（64±12岁，男性56％）接受了Tc-99m标记的单光子发射计算机断层显像（对MACE进行4.5±1.7年的SPECT）心肌灌注显像。通过视觉评估灌注异常并将其分类为正常，可能是正常，模棱两可或异常。自动量化的压力总灌注不足（TPD）分为TPD = 0％，TPD> 0％至<1％，≤1％至<3％，≤3％至<5％，≤5％至≤10％或TPD> 10％。MACE包括死亡，非致命性心肌梗塞，不稳定型心绞痛或晚期血运重建（> 90天）。进行了Kaplan-Meier和Cox比例风险分析，以测试视觉和定量评估在预测MACE中的表现。结果在随访检查中，发生了2,760（14.2％）个MACE。MACE比率随着视觉评估的恶化而增加，也就是说，正常MACE比率为2.0％，可能正常的比率为3.2％，模棱两可的比率为4.2％，异常的比率为7.4％（所有p <0.001）。MACE率随着压力TPD的增加而增加，从TPD类别的0％的1.3％到TPD类别的> 10％的7.8％（p <0.0001）。即使在模棱两可的评估中，MACE的调整后的危险比（HR）也会增加（HR：1.56； 95％置信区间[CI]：1.37至1。78），并且在TPD类别中，≤3％至<5％（HR：1.74； 95％CI：1.41至2.14；所有p <0.001）。视觉评估为正常的患者的MACE率仍从1.3％（TPD = 0％）增加到3.4％（TPD≥5％）（p <0.0001）。结论定量分析与视觉读数相比，即使对于具有正常临床读数的病例，也可以进行精确的粒度风险分层。