# Long-Term Prognostic Value in Nuclear Cardiology: Expert Scoring Combined with Automated Measurements vs. Angiographic Score

## TL;DR

Combining expert analysis and automated measurements in heart imaging provides better long-term predictions of cardiac events than traditional angiographic scoring.

## Contribution

Combining expert scoring with automated measurements improves prognostic accuracy compared to angiographic scores in coronary artery disease patients.

## Key findings

- Expert scoring combined with automated measurements outperformed angiographic scores for predicting hard cardiac events.
- The combination also showed superior prognostic value for any cardiac event compared to angiographic scores.
- Follow-up data showed 31.7% soft and 11.6% hard cardiac events in the study population.

## Abstract

The evaluation of myocardial perfusion imaging (MPI) studies is based on the visual interpretation of the reconstructed images, while the measurements obtained through software packages may contribute to the investigation, mainly in cases of ambiguous scintigraphic findings. We aimed to investigate the long-term prognostic value of expert reading of Summed Stress Score (SSS), Summed Rest Score (SRS), and Summed Difference Score (SDS), combined with the automated measurements of these parameters, in comparison to the prognostic ability of the angiographic score for soft and hard cardiac events. The study was conducted at the Nuclear Medicine Laboratory of the University of Thessaly, in Larissa, Greece. Overall, 378 consecutive patients with known or suspected coronary artery disease (CAD) were enrolled. Automated measurements of SSS, SRS, and SDS were obtained using the Emory Cardiac Toolbox, Myovation, and Quantitative Perfusion SPECT software packages. Coronary angiographies were scored according to a four-point scoring system (angiographic score). Follow-up data were recorded after phone contact, as well as through review of hospital records. All participants were followed up for at least 36 months. Soft and hard cardiac events were recorded in 31.7% and 11.6% of the sample, respectively, while any cardiac event was recorded in 36.5%. For hard cardiac events, the prognostic value of expert scoring, combined with the prognostic value of the automated measurements, was significantly greater compared to the prognostic ability of the angiographic score (p < 0.001). As far as any cardiac event, the prognostic value of expert scoring, combined with the prognostic value of the automated analyses, was significantly greater compared to the prognostic ability of the angiographic score (p < 0.001). According to our results, in patients with known or suspected CAD, the combination of expert reading and automated measurements of SSS, SRS, and SDS shows a superior prognostic ability in comparison to the angiographic score.