Construction and validation of a diagnostic model for obstructive coronary artery disease in patients with suspected unstable angina pectoris based on resting 18F-fluorodeoxyglucose positron emission tomography myocardial ischemia memory imaging

Figures

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  Figure 1. Research flowchart. ECG, electrocardiography; FDG, fluorodeoxyglucose; GRACE, Global Registry of Acute Coronary Events; NSTEMI, non-ST-segment elevation myocardial infarction; PET, positron emission tomography; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.

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  Figure 2. Four uptake patterns of 18F-FDG PET myocardial ischemia memory imaging. (A) The “no uptake” pattern. (B) The “uniform uptake” pattern. (C) The “focal uptake” pattern. (D) The “diffuse with focal uptake” pattern. FDG, fluorodeoxyglucose; PET, positron emission tomography.

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  Figure 3. A nomogram model for predicting the risk of OCAD in individuals with suspected unstable angina. Ischemia memory imaging: 18F-FDG PET myocardial ischemia memory imaging. FDG, fluorodeoxyglucose; LVEF, left ventricular ejection fraction; OCAD, obstructive coronary artery disease; PET, positron emission tomography.

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  Figure 4. ROC curve of obstructive coronary artery disease diagnostic model. AUC, area under the curve; CI, confidence interval; ROC, receiver operating characteristic.

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  Figure 5. Calibration curve of diagnostic model. The horizontal axis represents the predicted probability derived from the model, and the vertical axis denotes the actual observed frequency. The red solid line indicates the apparent curve of the model, while the black dashed line stands for the calibration curve after 1,000 bootstrap resamplings. The grey diagonal line is the ideal reference curve. The red shaded area refers to the 95% confidence interval of the prediction curve, and the grey histogram shows the distribution density of study samples across different predicted probabilities. CI, confidence interval; MAE, mean absolute error.

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  Figure 6. ROC curve corrected by 1,000 bootstrap resamplings. Solid red line: apparent ROC curve. Dotted blue line: optimism-corrected ROC curve. Shaded area: corrected 95% CI. AUC, area under the curve; CI, confidence interval; ROC, receiver operating characteristic.

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  Figure 7. Decision curve analysis of the diagnostic model. The red solid line represents the net benefit of using this diagnostic model; the blue dashed line represents the net benefit of treating all patients; the green dashed line represents the net benefit of treating no patients.

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  Figure 8. The ROC curves of the three diagnostic models, where the blue line represents Model 1, the orange line represents Model 2, and the green line represents Model 3. Model 1: only incorporating 5 clinical indicators. Model 2: only incorporating 18F-FDG PET myocardial ischemia memory imaging. Model 3: incorporating all 6 indicators. AUC, area under the curve; FDG, fluorodeoxyglucose; PET, positron emission tomography; ROC, receiver operating characteristic.