title: Use of bio-informatics assessment schema (BIAS) to improve diagnosis and prognosis of myocardial perfusion data: results from the NHLBI-sponsored women's ischemia syndrome evaluation (WISE).
abstract: BACKGROUND
  We introduce an algorithmic approach to optimize diagnostic and prognostic value of gated cardiac single photon emission computed tomography (SPECT) and magnetic resonance (MR) myocardial perfusion imaging (MPI) modalities in women with suspected myocardial ischemia. The novel approach: bio-informatics assessment schema (BIAS) forms a mathematical model utilizing MPI data and cardiac metrics generated by one modality to predict the MPI status of another modality. The model identifies cardiac features that either enhance or mask the image-based evidence of ischemia. For each patient, the BIAS model value is used to set an appropriate threshold for the detection of ischemia.
  
  
  METHODS
  Women (n=130), with symptoms and signs of suspected myocardial ischemia, underwent MPI assessment for regional perfusion defects using two different modalities: gated SPECT and MR. To determine perfusion status, MR data were evaluated qualitatively (MRIQL) and semi-quantitatively (MRISQ) while SPECT data were evaluated using conventional clinical criteria. Evaluators were masked to results of the alternate modality. These MPI status readings were designated "original". Two regression models designated "BIAS" models were generated to model MPI status obtained with one modality (e.g., MRI) compared with a second modality (e.g., SPECT), but importantly, the BIAS models did not include the primary Original MPI reading of the predicting modality. Instead, the BIAS models included auxiliary measurements like left ventricular chamber volumes and myocardial wall thickness. For each modality, the BIAS model was used to set a progressive threshold for interpretation of MPI status. Women were then followed for 38±14 months for the development of a first major adverse cardiovascular event [MACE: CV death, nonfatal myocardial infarction (MI) or hospitalization for heart failure]. Original and BIAS-augmented perfusion status were compared in their ability to detect coronary artery disease (CAD) and for prediction of MACE.
  
  
  RESULTS
  Adverse events occurred in 14 (11%) women and CAD was present in 13 (10%). There was a positive correlation of maximum coronary artery stenosis and BIAS score for MRI and SPECT (P<0.001). Receiver operator characteristic (ROC) analysis was conducted and showed an increase in the area under the curve of the BIAS-augmented MPI interpretation of MACEvs. the original for MRISQ(0.78vs. 0.54), MRIQL(0.78vs. 0.64), SPECT (0.82vs. 0.63) and the average of the three readings (0.80±0.02vs. 0.60±0.05, P<0.05).
  
  
  CONCLUSIONS
  Increasing values of the BIAS score generated by both MRI and SPECT corresponded to the increasing prevalence of CAD and MACE. The BIAS-augmented detection of ischemia better predicted MACE compared with the Original reading for the MPI data for both MRI and SPECT.
authors.affiliation: Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Doyle
authors.affiliation: Keck Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Pohost
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: National Heart Lung and Blood Institute, NIH, USA.
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: William J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.affiliation: University of Florida, Gainesville, FL, USA.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.affiliation: Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Diane V
authors.initials: DV
authors.lastname: Thompson
authors.affiliation: Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Geetha
authors.initials: G
authors.lastname: Rayarao
authors.forename: Lindsey
authors.initials: L
authors.lastname: Tauxe
authors.affiliation: Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.affiliation: Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Robert W W
authors.initials: RW
authors.lastname: Biederman
keywords: Modeling; diagnosis; myocardial perfusion imaging (MPI); prognosis; women