Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation
Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation
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DOI：
10.1016/j.nuclcard.2004.03.033
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发表时间：
2004-07-01
影响因子：
2.4
通讯作者：
Hachamovitch, R
中科院分区：
文献类型：
--
作者：
Berman, DS;Abidov, A;Hachamovitch, R
背景。最近，左心室 17 节段模型被推荐作为解释心肌灌注单光子发射计算机断层扫描 (SPECT) 的最佳加权方法。需要将数据库从以前的 20 段数据转换为新的 17 段数据的方法以及 17 段评分异常的标准。方法和结果。最初，为了推导转换算法，研究了 65 名患者（算法群体）（试验组，n = 28；验证组，n = 37）。导出了三种转换算法：算法 1，使用中、远端和顶端分数；算法 2，仅使用远端和顶端评分；算法3，其使用20节段模型中远端间隔、侧向和心尖节段的最大分数作为17节段模型的3个相应节段。预后人群包括 16,020 名连续患者（平均年龄 65 +/- 12 岁；41% 为女性），他们接受了运动或血管扩张剂应激锝 99m sestamibi 心肌灌注 SPECT，并随访了 2.1 +/- 0.8 年。在此群体中，17 段分数是通过使用算法 2 从 20 段分数得出的，这证明了与算法群体中专家 17 段阅读的最佳一致性。通过将各自的总分数转换为心肌异常百分比来比较 20 段和 17 段分数的预后价值。发现转换算法 2 与算法群体中 17 段模型（r = 0.982；kappa = 0.866）的专家视觉分析高度一致。在预后人群中，随访期间发生了 456 例心源性死亡。当应用转换算法时，20 段评分和派生的 17 段评分的灌注缺陷的范围和严重程度几乎相同。 20 段和 17 段灌注评分的受试者工作特征曲线面积在预测心源性死亡方面是相同的（均为 0.77 +/- 0.02，P = 不显着）。 20 节段或派生的 17 节段模型的最佳预后截止值被证实为 5% 心肌异常，对应于压力评分总和大于 3。值得注意的是，17 节段模型表现出轻度异常扫描较少、正常和严重异常扫描较多的趋势。结论。我们开发了一种将 20 段灌注评分转换为 17 段评分的算法，该算法与 17 段模型的专家视觉分析高度一致，并提供几乎相同的预后信息。该转换模型可以提供一种机制，用于将 17 段系统分析的研究与先前用 20 段方法分析的研究进行比较。
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; kappa = 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.