The predictive value of Cardiodynamicsgram in myocardial perfusion abnormalities

Abstract

Myocardial perfusion abnormalities are the first sign of the ischemic cascade in the development of coronary artery disease (CAD). Thus, the early detection of myocardial perfusion abnormalities is significant for the prevention of CAD. Recently, a novel noninvasive method named Cardiodynamicsgram (CDG) has been proposed for early detection of CAD. This study aims to evaluate the predictive value of CDG in myocardial perfusion abnormalities for suspected ischemic heart disease. In the study, 86 suspected patients were enrolled. Standard 12-lead ECG and CDG were performed simultaneously before single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Diagnostic accuracy of CDG for myocardial perfusion abnormalities detection is assessed using SPECT MPI as the reference standard. Of these 86 suspected patients, 37 patients were positive in CDG, 49 patients were negative in CDG. Diagnostic accuracy of CDG at presentation for myocardial perfusion abnormalities was 84.9%, sensitivity 84.0%, and specificity 89.4%. Furthermore, of the 10 patients whose SPECT MPI results are reverse redistribution, 9 patients were positive in CDG. Underlying causes of false positive CDG findings included the factors that can change the stability of cardiac electrical conduction and measurement noise. Myocardial remodeling in patients with old myocardial infarction might be the major cause of false negative findings. Results show a good consistency between the CDG and SPECT MPI in evaluating myocardial perfusion abnormalities. It suggests that CDG might be used as a cost-effective tool for assessing the myocardial perfusion abnormalities in the clinic.

Fig 1. The ST-T segment of ECG used to construct CDG.

Fig 2. Two cases of CDG.

(a): A case of a 23-year-old healthy subject. (b): A case of a 55-year-old female who suffered from ischemia.

Fig 3. The ECG, CDG and DI of GB0527.

GB0527 is a 50-year-old male patient, ECG is normal, and CDG is positive with DI = 0.45.

Fig 4. SPECT MPI results of GB0527.

The rest and stress SPECT ischemia score of GB0527 are 0 and 3, respectively.

Fig 5. The ECG, CDG and DI of GB0880.

GB0880 is a 42-year-old male patient with moderately severe stenosis, ECG is normal, and CDG is positive with DI = 2.13.

Fig 6. SPECT MPI results of GB0880.

The rest and stress SPECT ischemia score of GB0527 are 0 and 18, respectively.

Fig 7. The ECG, CDG and DI of GB0515.

GB0515 is a 68-year-old female patient was with the symptom of chest pain and abnormal ECG, and CDG is negative with DI = −6.03.

Fig 8. SPECT MPI results of GB0515.

Both rest and stress SPECT ischemia score of GB0527 are 0.

Fig 9. Receiver-operating characteristic curves of CDG for the three experiments.

The areas under the three ROC curves were 0.759 (the 95% confidence interval 0.653 to 0.865), 0.756(the 95% confidence interval 0.632 to 0.881), and 0.799(the 95% confidence interval 0.691 to 0.907), respectively.

Fig 10. Receiver-operating characteristic curves of CDG, ECG and exercise ECG.

The areas under the three ROC curves were 0.759 (the 95% confidence interval 0.653 to 0.865), and 0.521(the 95% confidence interval 0.396 to 0.645), 0.621(the 95% confidence interval 0.497 to 0.744), respectively.