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Angelidis G, Giannakou S, Valotassiou V, Tsougos I, Tzavara C, Psimadas D, Theodorou E, Ziaka A, Ziangas C, Skoularigis J, Triposkiadis F, Georgoulias P. Long-Term Prognostic Value of Automated Measurements in Nuclear Cardiology: Comparisons with Expert Scoring. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1738. [PMID: 37893456 PMCID: PMC10607987 DOI: 10.3390/medicina59101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Automated methods for the analysis of myocardial perfusion studies have been incorporated into clinical practice, but they are currently used as adjuncts to the visual interpretation. We aimed to investigate the role of automated measurements of summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) as long-term prognostic markers of morbidity and mortality, in comparison to the prognostic value of expert reading. Materials and Methods: The study was conducted at the Nuclear Medicine Laboratory of the University of Thessaly, in Larissa, Greece. A total of 378 consecutive patients with known or suspected coronary artery disease were enrolled in the study. All participants were referred to our laboratory for the performance of stress/rest myocardial perfusion single photon emission computed tomography. Automated measurements of SSS, SRS, and SDS were obtained by Emory Cardiac Toolbox (ECTb (Version 3.0), Emory University, Atlanta, GA, USA), Myovation (MYO, Xeleris version 3.05, GE Healthcare, Chicago, IL, USA), and Quantitative Perfusion SPECT (QPS (Version 4.0), Cedars-Sinai Medical Center, Los Angeles, CA, USA) software packages. Follow-up data were recorded after phone contacts, as well as through review of hospital records. Results: Expert scoring of SSS and SDS had significantly greater prognostic ability in comparison to all software packages (p < 0.001 for all comparisons). Similarly, ECTb-obtained SRS measurements had significantly lower prognostic ability in comparison to expert scoring (p < 0.001), while expert scoring of SRS showed significantly higher prognostic ability compared to MYO (p = 0.018) and QPS (p < 0.001). Conclusions: Despite the useful contribution of automated analyses in the interpretation of myocardial perfusion studies, expert reading should continue to have a crucial role, not only in clinical decision making, but also in the assessment of prognosis.
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Affiliation(s)
- George Angelidis
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Stavroula Giannakou
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Varvara Valotassiou
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Ioannis Tsougos
- Medical Physics Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Chara Tzavara
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Dimitrios Psimadas
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Evdoxia Theodorou
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Anastasia Ziaka
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Charalampos Ziangas
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Panagiotis Georgoulias
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Mezourlo, 41110 Larissa, Greece
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Angelidis G, Valotassiou V, Satra M, Psimadas D, Koutsikos J, Skoularigis J, Kollia P, Georgoulias P. Investigating the genetic characteristics of CAD: Is there a role for myocardial perfusion imaging techniques? J Nucl Cardiol 2022; 29:2909-2916. [PMID: 33141407 DOI: 10.1007/s12350-020-02403-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/02/2020] [Indexed: 01/18/2023]
Abstract
Several environmental and genetic factors have been found to influence the development and progression of coronary artery disease (CAD). Although the effects of the environmental hazards on CAD pathophysiology are well documented, the genetic architecture of the disease remains quite unclear. A number of single-nucleotide polymorphisms have been identified based on the results of the genome-wide association studies. However, there is a lack of strong evidence regarding molecular causality. The minority of the reported predisposing variants can be related to the conventional risk factors of CAD, while most of the polymorphisms occur in non-protein-coding regions of the DNA. However, independently of the specific underlying mechanisms, genetic information could lead to the identification of a population at higher genetic risk for the long-term development of CAD. Myocardial single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are functional imaging techniques that can evaluate directly myocardial perfusion, and detect vascular and/or endothelial dysfunction. Therefore, these techniques could have a role in the investigation of the underlying mechanisms associated with the identified predisposing variants, advancing our understanding regarding molecular causality. In the population at higher genetic risk, myocardial SPECT or PET could provide important evidence through the early depiction of sub-clinical dysfunctions, well before any atherosclerosis marker could be identified. Notably, SPECT and PET techniques have been already used for the investigation of the functional consequences of several CAD-related polymorphisms, as well as the response to certain treatments (statins). Furthermore, therefore, in the clinical setting, the combination of genetic evidence with the findings of myocardial SPECT, or PET, functional imaging techniques could lead to more efficient screening methods and may improve decision making with regard to the diagnostic investigation and patients' management.
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Affiliation(s)
- G Angelidis
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
| | - V Valotassiou
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - M Satra
- Biology & Genetics Laboratory, University of Thessaly, Larissa, Greece
| | - D Psimadas
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - J Koutsikos
- Department of Nuclear Medicine, 401 General Military Hospital, Athens, Greece
| | - J Skoularigis
- Department of Cardiology, University of Thessaly, Larissa, Greece
| | - P Kollia
- Department of Genetics & Biotechnology, Faculty of Biology, National & Kapodistrian University of Athens, Athens, Greece
| | - P Georgoulias
- Nuclear Medicine Laboratory, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Automated Analysis vs. Expert Reading in Nuclear Cardiology: Correlations with the Angiographic Score. Medicina (B Aires) 2022; 58:medicina58101432. [PMID: 36295592 PMCID: PMC9610262 DOI: 10.3390/medicina58101432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Myocardial perfusion imaging (MPI) has an important role in the non-invasive investigation of coronary artery disease. The interpretation of MPI studies is mainly based on the visual evaluation of the reconstructed images, while automated quantitation methods may add useful data for each patient. However, little evidence is currently available regarding the actual incremental clinical diagnostic performance of automated MPI analysis. In the present study, we aimed to assess the correlation between automated measurements of Summed Stress Score (SSS), Summed Rest Score (SRS) and Summed Difference Score (SDS), with the corresponding expert reading values, using coronary angiography as the gold standard. Materials and Methods: The study was conducted at the Nuclear Medicine Laboratory of the University Hospital of Larissa, Larissa, Greece, οver an one-year period (January 2019–January 2020). 306 patients, with known or suspected coronary artery disease, were enrolled in the study. Each participant underwent a coronary angiography, prior to or after the scintigraphic study (within a three-month period). Either symptom-limited treadmill test, or pharmacologic testing using adenosine or regadenoson, was performed in all participants, and the scintigraphic studies were carried out using technetium 99m (99mTc) tetrofosmin (one-day stress/rest protocol). Coronary angiographies were scored according to a 4-point scoring system (angiographic score; O: normal study, 1: one-vessel disease, 2: two-vessel disease, 3: three-vessel disease). Moreover, automated measurements of SSS, SRS and SDS were derived by three widely available software packages (Emory Cardiac Toolbox, Myovation, Quantitative Perfusion SPECT). Results: Interclass Correlation Coefficients of SSS, SRS and SDS between expert reading and software packages were moderate to excellent. Visually defined SSS, SRS and SDS were significantly correlated with the corresponding results of all software packages. However, visually defined SSS, SRS and SDS were more strongly correlated with the angiographic score, indicating a better performance of expert reading when compared to automated analysis. Conclusions: Based on our results, visual evaluation continues to have a crucial role for the interpretation of MPI images. Software packages can provide automated measurements of several parameters, particularly contributing to the investigation of cases with ambiguous scintigraphic findings.
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Angelidis G, Valotassiou V, Kollia P, Skoularigis J, Tsougos I, Georgoulias P. Novel approaches for the management of coronary artery disease. Herz 2020; 46:89-90. [PMID: 32006079 DOI: 10.1007/s00059-019-04885-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- G Angelidis
- Nuclear Medicine Laboratory, University Hospital of Larissa, Larissa, Greece.
| | - V Valotassiou
- Nuclear Medicine Laboratory, University Hospital of Larissa, Larissa, Greece
| | - P Kollia
- Faculty of Biology, National & Kapodistrian University of Athens, Athens, Greece
| | - J Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece
| | - I Tsougos
- Nuclear Medicine Laboratory, University Hospital of Larissa, Larissa, Greece
| | - P Georgoulias
- Nuclear Medicine Laboratory, University Hospital of Larissa, Larissa, Greece
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Marie PY, Visvikis-Siest S. Do we need diagnostic strategies enhanced with genetic information for ischemic heart disease? J Nucl Cardiol 2019; 26:1309-1312. [PMID: 29511928 DOI: 10.1007/s12350-018-1240-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Pierre-Yves Marie
- Nuclear Medicine & Nancyclotep Experimental Platform, CHRU-Nancy, Université de Lorraine, 54000, Nancy, France.
- INSERM, UMR-1116, Université de Lorraine, 54000, Nancy, France.
| | - Sophie Visvikis-Siest
- INSERM, UMR-1122, Université de Lorraine, 54000, Nancy, France
- Department of Internal Medicine and Geriatrics, CHRU-Nancy, Université de Lorraine, 54511, Nancy, France
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