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Wang F, Yuan H, Lv J, Han X, Zhou Z, Lu W, Lu L, Jiang L. Stress-only versus rest-stress SPECT MPI in the detection and diagnosis of myocardial ischemia and infarction by machine learning. Nucl Med Commun 2024; 45:35-44. [PMID: 37823249 DOI: 10.1097/mnm.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Rest-stress SPECT myocardial perfusion imaging (MPI) is widely used to evaluate coronary artery disease (CAD). We aim to evaluate stress-only versus rest-stress MPI in diagnosing CAD by machine learning (ML). METHODS A total of 276 patients with suspected CAD were randomly divided into training (184 patients) and validation (92 patients) cohorts. Variables extracted from clinical, physiological, and rest-stress SPECT MPI were screened. Stress-only and rest-stress MPI using ML were established and compared using the training cohort. Then the diagnostic performance of two models in diagnosing myocardial ischemia and infarction was evaluated in the validation cohort. RESULTS Six ML models based on stress-only MPI selected summed stress score, summed wall thickness score of stress%, and end-diastolic volume of stress as key variables and performed equally good as rest-stress MPI in detecting CAD [area under the curve (AUC): 0.863 versus 0.877, P = 0.519]. Furthermore, stress-only MPI showed a reasonable prediction of reversible deficit, as shown by rest-stress MPI (AUC: 0.861). Subsequently, nomogram models using the above-stated stress-only MPI variables showed a good prediction of CAD and reversible perfusion deficit in training and validation cohorts. CONCLUSION Stress-only MPI demonstrated similar diagnostic performance compared with rest-stress MPI using 6 ML algorithms. Stress-only MPI with ML models can diagnose CAD and predict ischemia from scar.
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Affiliation(s)
- Fanghu Wang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University,
| | - Hui Yuan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University,
| | - Jieqin Lv
- Department of Nuclear Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,
| | - Xu Han
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University,
| | - Zidong Zhou
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University,
| | - Wantong Lu
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University,
| | - Lijun Lu
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University,
- Pazhou Lab and
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University,
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
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Zaichenko KV, Kordyukova AA, Sonin DL, Galagudza MM. Ultra-High-Resolution Electrocardiography Enables Earlier Detection of Transmural and Subendocardial Myocardial Ischemia Compared to Conventional Electrocardiography. Diagnostics (Basel) 2023; 13:2795. [PMID: 37685333 PMCID: PMC10486484 DOI: 10.3390/diagnostics13172795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
The sensitivity of exercise ECG is marginally sufficient for the detection of mild reduction of coronary blood flow in patients with early coronary atherosclerosis. Here, we describe the application of a new technique of ECG registration/analysis-ultra-high-resolution ECG (UHR ECG)-for early detection of myocardial ischemia (MIS). The utility of UHR ECG vs. conventional ECG (C ECG) was tested in anesthetized rats and pigs. Transmural MIS was induced in rats by the ligation of the left coronary artery (CA). In pigs, subendocardial ischemia of a variable extent was produced by stepwise inflation of a balloon within the right CA, causing a 25-100% reduction of its lumen. In rats, a reduction in power spectral density (PSD) in the high-frequency (HF) channel of UHR ECG was registered at 60 s after ischemia (power 0.81 ± 0.14 vs. 1.25 ± 0.12 mW at baseline, p < 0.01). This was not accompanied by any ST segment elevation on C ECG. In pigs, PSD in the HF channel of UHR ECG was significantly decreased at a 25% reduction of CA lumen, while the ST segment on C ECG remained unchanged. In conclusion, UHR ECG enabled earlier detection of transmural MIS compared to C ECG. PSD in the HF channel of UHR ECG demonstrated greater sensitivity in the settings of subendocardial ischemia.
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Affiliation(s)
- Kirill V. Zaichenko
- Laboratory of Radio- and Optoelectronic Devices for Early Diagnostics of Living Systems Pathologies, The Institute for Analytical Instrumentation, Russian Academy of Sciences, 31-33A Ivana Chernykh Street, 198095 Saint Petersburg, Russia; (K.V.Z.); (D.L.S.)
| | - Anna A. Kordyukova
- Laboratory of Radio- and Optoelectronic Devices for Early Diagnostics of Living Systems Pathologies, The Institute for Analytical Instrumentation, Russian Academy of Sciences, 31-33A Ivana Chernykh Street, 198095 Saint Petersburg, Russia; (K.V.Z.); (D.L.S.)
| | - Dmitry L. Sonin
- Laboratory of Radio- and Optoelectronic Devices for Early Diagnostics of Living Systems Pathologies, The Institute for Analytical Instrumentation, Russian Academy of Sciences, 31-33A Ivana Chernykh Street, 198095 Saint Petersburg, Russia; (K.V.Z.); (D.L.S.)
- Department of Microcirculation and Myocardial Metabolism, Institute of Experimental Medicine, Almazov National Medical Research Centre, 15B Parkhomenko Street, 194021 Saint Petersburg, Russia
| | - Michael M. Galagudza
- Laboratory of Radio- and Optoelectronic Devices for Early Diagnostics of Living Systems Pathologies, The Institute for Analytical Instrumentation, Russian Academy of Sciences, 31-33A Ivana Chernykh Street, 198095 Saint Petersburg, Russia; (K.V.Z.); (D.L.S.)
- Department of Microcirculation and Myocardial Metabolism, Institute of Experimental Medicine, Almazov National Medical Research Centre, 15B Parkhomenko Street, 194021 Saint Petersburg, Russia
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Mikail N, Chequer R, Imperiale A, Meisel A, Bengs S, Portmann A, Gimelli A, Buechel RR, Gebhard C, Rossi A. Tales from the future-nuclear cardio-oncology, from prediction to diagnosis and monitoring. Eur Heart J Cardiovasc Imaging 2023; 24:1129-1145. [PMID: 37467476 PMCID: PMC10501471 DOI: 10.1093/ehjci/jead168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
Cancer and cardiovascular diseases (CVD) often share common risk factors, and patients with CVD who develop cancer are at high risk of experiencing major adverse cardiovascular events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients' prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced non-invasive cardiac imaging has raised great interest in the early detection of CVD and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer-treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments and discuss the specific role of nuclear cardiology alongside other non-invasive imaging techniques.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Renata Chequer
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018 Paris, France
| | - Alessio Imperiale
- Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67093 Strasbourg, France
- Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, 67093 Strasbourg, France
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Kantonsspital Glarus, Burgstrasse 99, 8750 Glarus, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Alessia Gimelli
- Imaging Department, Fondazione CNR/Regione Toscana Gabriele Monasterio, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
- Department of Cardiology, University Hospital Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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Miller RJH, Huang C, Liang JX, Slomka PJ. Artificial intelligence for disease diagnosis and risk prediction in nuclear cardiology. J Nucl Cardiol 2022; 29:1754-1762. [PMID: 35508795 DOI: 10.1007/s12350-022-02977-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
Artificial intelligence (AI) techniques have emerged as a highly efficient approach to accurately and rapidly interpret diagnostic imaging and may play a vital role in nuclear cardiology. In nuclear cardiology, there are many clinical, stress, and imaging variables potentially available, which need to be optimally integrated to predict the presence of obstructive coronary artery disease (CAD) or predict the risk of cardiovascular events. In spite of clinical awareness of a large number of potential variables, it is difficult for physicians to integrate multiple features consistently and objectively. Machine learning (ML) is particularly well suited to integrating this vast array of information to provide patient-specific predictions. Deep learning (DL), a branch of ML characterized by a multi-layered convolutional model architecture, can extract information directly from images and identify latent image features associated with a specific prediction. This review will discuss the latest AI applications to disease diagnosis and risk prediction in nuclear cardiology with a focus on potential clinical applications.
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Affiliation(s)
- Robert J H Miller
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Cathleen Huang
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA
| | - Joanna X Liang
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA.
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