Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy

Hulya Yalcin, Ines Valenta, Min Zhao, Abdel Tahari, Dai Yin Lu, Takahiro Higuchi, Fatih Yalcin, Nagehan Kucukler, Yalda Soleimanifard, Yun Zhou, Martin Gilbert Pomper, Theodore P. Abraham, Benjamin Tsui, Martin Lodge, Thomas H. Schindler, M. Roselle Abraham

Research output: Contribution to journalArticle

Abstract

Backgorund: Quantification of myocardial blood flow (MBF) by positron emission tomography (PET) is important for investigation of angina in hypertrophic cardiomyopathy (HCM). Several software programs exist for MBF quantification, but they have been mostly evaluated in patients (with normal cardiac geometry), referred for evaluation of coronary artery disease (CAD). Software performance has not been evaluated in HCM patients who frequently have hyperdynamic LV function, LV outflow tract (LVOT) obstruction, small LV cavity size, and variation in the degree/location of LV hypertrophy. Aim: We compared results of MBF obtained using PMod, which permits manual segmentation, to those obtained by FDA-approved QPET software which has an automated segmentation algorithm. Methods: 13N-ammonia PET perfusion data were acquired in list mode at rest and during pharmacologic vasodilation, in 76 HCM patients and 10 non-HCM patients referred for evaluation of CAD (CAD group.) Data were resampled to create static, ECG-gated and 36-frame-dynamic images. Myocardial flow reserve (MFR) and MBF (in ml/min/g) were calculated using QPET and PMod softwares. Results: All HCM patients had asymmetric septal hypertrophy, and 50% had evidence of LVOT obstruction, whereas non-HCM patients (CAD group) had normal wall thickness and ejection fraction. PMod yielded significantly higher values for global and regional stress-MBF and MFR than for QPET in HCM. Reasonably fair correlation was observed for global rest-MBF, stress-MBF, and MFR using these two softwares (rest-MBF: r = 0.78; stress-MBF: r = 0.66.; MFR: r = 0.7) in HCM patients. Agreement between global MBF and MFR values improved when HCM patients with high spillover fractions (> 0.65) were excluded from the analysis (rest-MBF: r = 0.84; stress-MBF: r = 0.72; MFR: r = 0.8.) Regionally, the highest agreement between PMod and QPET was observed in the LAD territory (rest-MBF: r = 0.82, Stress-MBF: r = 0.68) where spillover fraction was the lowest. Unlike HCM patients, the non-HCM patients (CAD group) demonstrated excellent agreement in MBF/MFR values, obtained by the two softwares, when patients with high spillover fractions were excluded (rest-MBF: r = 0.95; stress-MBF: r = 0.92; MFR: r = 0.95). Conclusions: Anatomic characteristics specific to HCM hearts contribute to lower correlations between MBF/MFR values obtained by PMod and QPET, compared with non-HCM patients. These differences indicate that PMod and QPET cannot be used interchangeably for MBF/MFR analyses in HCM patients.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalJournal of Nuclear Cardiology
DOIs
StateAccepted/In press - Jan 22 2018

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Hypertrophic Cardiomyopathy
Software
Coronary Artery Disease
Cardiomyopathies
Positron-Emission Tomography
Hypertrophy

Keywords

  • Hypertrophic cardiomyopathy
  • myocardial blood flow
  • N-13 Ammonia PET
  • quantitative analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy. / Yalcin, Hulya; Valenta, Ines; Zhao, Min; Tahari, Abdel; Lu, Dai Yin; Higuchi, Takahiro; Yalcin, Fatih; Kucukler, Nagehan; Soleimanifard, Yalda; Zhou, Yun; Pomper, Martin Gilbert; Abraham, Theodore P.; Tsui, Benjamin; Lodge, Martin; Schindler, Thomas H.; Roselle Abraham, M.

In: Journal of Nuclear Cardiology, 22.01.2018, p. 1-11.

Research output: Contribution to journalArticle

Yalcin, H, Valenta, I, Zhao, M, Tahari, A, Lu, DY, Higuchi, T, Yalcin, F, Kucukler, N, Soleimanifard, Y, Zhou, Y, Pomper, MG, Abraham, TP, Tsui, B, Lodge, M, Schindler, TH & Roselle Abraham, M 2018, 'Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy', Journal of Nuclear Cardiology, pp. 1-11. https://doi.org/10.1007/s12350-017-1155-x
Yalcin, Hulya ; Valenta, Ines ; Zhao, Min ; Tahari, Abdel ; Lu, Dai Yin ; Higuchi, Takahiro ; Yalcin, Fatih ; Kucukler, Nagehan ; Soleimanifard, Yalda ; Zhou, Yun ; Pomper, Martin Gilbert ; Abraham, Theodore P. ; Tsui, Benjamin ; Lodge, Martin ; Schindler, Thomas H. ; Roselle Abraham, M. / Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy. In: Journal of Nuclear Cardiology. 2018 ; pp. 1-11.
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title = "Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy",
abstract = "Backgorund: Quantification of myocardial blood flow (MBF) by positron emission tomography (PET) is important for investigation of angina in hypertrophic cardiomyopathy (HCM). Several software programs exist for MBF quantification, but they have been mostly evaluated in patients (with normal cardiac geometry), referred for evaluation of coronary artery disease (CAD). Software performance has not been evaluated in HCM patients who frequently have hyperdynamic LV function, LV outflow tract (LVOT) obstruction, small LV cavity size, and variation in the degree/location of LV hypertrophy. Aim: We compared results of MBF obtained using PMod, which permits manual segmentation, to those obtained by FDA-approved QPET software which has an automated segmentation algorithm. Methods: 13N-ammonia PET perfusion data were acquired in list mode at rest and during pharmacologic vasodilation, in 76 HCM patients and 10 non-HCM patients referred for evaluation of CAD (CAD group.) Data were resampled to create static, ECG-gated and 36-frame-dynamic images. Myocardial flow reserve (MFR) and MBF (in ml/min/g) were calculated using QPET and PMod softwares. Results: All HCM patients had asymmetric septal hypertrophy, and 50{\%} had evidence of LVOT obstruction, whereas non-HCM patients (CAD group) had normal wall thickness and ejection fraction. PMod yielded significantly higher values for global and regional stress-MBF and MFR than for QPET in HCM. Reasonably fair correlation was observed for global rest-MBF, stress-MBF, and MFR using these two softwares (rest-MBF: r = 0.78; stress-MBF: r = 0.66.; MFR: r = 0.7) in HCM patients. Agreement between global MBF and MFR values improved when HCM patients with high spillover fractions (> 0.65) were excluded from the analysis (rest-MBF: r = 0.84; stress-MBF: r = 0.72; MFR: r = 0.8.) Regionally, the highest agreement between PMod and QPET was observed in the LAD territory (rest-MBF: r = 0.82, Stress-MBF: r = 0.68) where spillover fraction was the lowest. Unlike HCM patients, the non-HCM patients (CAD group) demonstrated excellent agreement in MBF/MFR values, obtained by the two softwares, when patients with high spillover fractions were excluded (rest-MBF: r = 0.95; stress-MBF: r = 0.92; MFR: r = 0.95). Conclusions: Anatomic characteristics specific to HCM hearts contribute to lower correlations between MBF/MFR values obtained by PMod and QPET, compared with non-HCM patients. These differences indicate that PMod and QPET cannot be used interchangeably for MBF/MFR analyses in HCM patients.",
keywords = "Hypertrophic cardiomyopathy, myocardial blood flow, N-13 Ammonia PET, quantitative analysis",
author = "Hulya Yalcin and Ines Valenta and Min Zhao and Abdel Tahari and Lu, {Dai Yin} and Takahiro Higuchi and Fatih Yalcin and Nagehan Kucukler and Yalda Soleimanifard and Yun Zhou and Pomper, {Martin Gilbert} and Abraham, {Theodore P.} and Benjamin Tsui and Martin Lodge and Schindler, {Thomas H.} and {Roselle Abraham}, M.",
year = "2018",
month = "1",
day = "22",
doi = "10.1007/s12350-017-1155-x",
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TY - JOUR

T1 - Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy

AU - Yalcin, Hulya

AU - Valenta, Ines

AU - Zhao, Min

AU - Tahari, Abdel

AU - Lu, Dai Yin

AU - Higuchi, Takahiro

AU - Yalcin, Fatih

AU - Kucukler, Nagehan

AU - Soleimanifard, Yalda

AU - Zhou, Yun

AU - Pomper, Martin Gilbert

AU - Abraham, Theodore P.

AU - Tsui, Benjamin

AU - Lodge, Martin

AU - Schindler, Thomas H.

AU - Roselle Abraham, M.

PY - 2018/1/22

Y1 - 2018/1/22

N2 - Backgorund: Quantification of myocardial blood flow (MBF) by positron emission tomography (PET) is important for investigation of angina in hypertrophic cardiomyopathy (HCM). Several software programs exist for MBF quantification, but they have been mostly evaluated in patients (with normal cardiac geometry), referred for evaluation of coronary artery disease (CAD). Software performance has not been evaluated in HCM patients who frequently have hyperdynamic LV function, LV outflow tract (LVOT) obstruction, small LV cavity size, and variation in the degree/location of LV hypertrophy. Aim: We compared results of MBF obtained using PMod, which permits manual segmentation, to those obtained by FDA-approved QPET software which has an automated segmentation algorithm. Methods: 13N-ammonia PET perfusion data were acquired in list mode at rest and during pharmacologic vasodilation, in 76 HCM patients and 10 non-HCM patients referred for evaluation of CAD (CAD group.) Data were resampled to create static, ECG-gated and 36-frame-dynamic images. Myocardial flow reserve (MFR) and MBF (in ml/min/g) were calculated using QPET and PMod softwares. Results: All HCM patients had asymmetric septal hypertrophy, and 50% had evidence of LVOT obstruction, whereas non-HCM patients (CAD group) had normal wall thickness and ejection fraction. PMod yielded significantly higher values for global and regional stress-MBF and MFR than for QPET in HCM. Reasonably fair correlation was observed for global rest-MBF, stress-MBF, and MFR using these two softwares (rest-MBF: r = 0.78; stress-MBF: r = 0.66.; MFR: r = 0.7) in HCM patients. Agreement between global MBF and MFR values improved when HCM patients with high spillover fractions (> 0.65) were excluded from the analysis (rest-MBF: r = 0.84; stress-MBF: r = 0.72; MFR: r = 0.8.) Regionally, the highest agreement between PMod and QPET was observed in the LAD territory (rest-MBF: r = 0.82, Stress-MBF: r = 0.68) where spillover fraction was the lowest. Unlike HCM patients, the non-HCM patients (CAD group) demonstrated excellent agreement in MBF/MFR values, obtained by the two softwares, when patients with high spillover fractions were excluded (rest-MBF: r = 0.95; stress-MBF: r = 0.92; MFR: r = 0.95). Conclusions: Anatomic characteristics specific to HCM hearts contribute to lower correlations between MBF/MFR values obtained by PMod and QPET, compared with non-HCM patients. These differences indicate that PMod and QPET cannot be used interchangeably for MBF/MFR analyses in HCM patients.

AB - Backgorund: Quantification of myocardial blood flow (MBF) by positron emission tomography (PET) is important for investigation of angina in hypertrophic cardiomyopathy (HCM). Several software programs exist for MBF quantification, but they have been mostly evaluated in patients (with normal cardiac geometry), referred for evaluation of coronary artery disease (CAD). Software performance has not been evaluated in HCM patients who frequently have hyperdynamic LV function, LV outflow tract (LVOT) obstruction, small LV cavity size, and variation in the degree/location of LV hypertrophy. Aim: We compared results of MBF obtained using PMod, which permits manual segmentation, to those obtained by FDA-approved QPET software which has an automated segmentation algorithm. Methods: 13N-ammonia PET perfusion data were acquired in list mode at rest and during pharmacologic vasodilation, in 76 HCM patients and 10 non-HCM patients referred for evaluation of CAD (CAD group.) Data were resampled to create static, ECG-gated and 36-frame-dynamic images. Myocardial flow reserve (MFR) and MBF (in ml/min/g) were calculated using QPET and PMod softwares. Results: All HCM patients had asymmetric septal hypertrophy, and 50% had evidence of LVOT obstruction, whereas non-HCM patients (CAD group) had normal wall thickness and ejection fraction. PMod yielded significantly higher values for global and regional stress-MBF and MFR than for QPET in HCM. Reasonably fair correlation was observed for global rest-MBF, stress-MBF, and MFR using these two softwares (rest-MBF: r = 0.78; stress-MBF: r = 0.66.; MFR: r = 0.7) in HCM patients. Agreement between global MBF and MFR values improved when HCM patients with high spillover fractions (> 0.65) were excluded from the analysis (rest-MBF: r = 0.84; stress-MBF: r = 0.72; MFR: r = 0.8.) Regionally, the highest agreement between PMod and QPET was observed in the LAD territory (rest-MBF: r = 0.82, Stress-MBF: r = 0.68) where spillover fraction was the lowest. Unlike HCM patients, the non-HCM patients (CAD group) demonstrated excellent agreement in MBF/MFR values, obtained by the two softwares, when patients with high spillover fractions were excluded (rest-MBF: r = 0.95; stress-MBF: r = 0.92; MFR: r = 0.95). Conclusions: Anatomic characteristics specific to HCM hearts contribute to lower correlations between MBF/MFR values obtained by PMod and QPET, compared with non-HCM patients. These differences indicate that PMod and QPET cannot be used interchangeably for MBF/MFR analyses in HCM patients.

KW - Hypertrophic cardiomyopathy

KW - myocardial blood flow

KW - N-13 Ammonia PET

KW - quantitative analysis

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