Comparative Evaluation of 3 Cardiac Software Packages for Analysis of MPI and Derived Quantitative Parameters Vis-à-Vis 2D Echocardiography

Myocardial perfusion scintigraphy and 2-dimensional (2D) echocardiography are used for evaluating left ventricular function and ejection fraction (EF). This study aimed to validate the semiquantitative and functional parameters derived from 3 available software packages (Emory Cardiac Toolbox, Cardiogam, and Myovation Evolution) and compare the software-derived EF with that obtained with 2D echocardiography. <b>Methods:</b> This prospective investigation included 370 patients who underwent myocardial perfusion scintigraphy. The participants were stratified into 3 groups on the basis of their left ventricular EF determined by 2D echocardiography. The semiquantitative parameters (summed rest score, summed stress score, summed difference score) and quantitative parameters (defect extent, transient ischemic dilation, EF, end-diastolic volume, end-systolic volume, and stroke volume) derived from each software platform were analyzed. Spearman rank correlation coefficient and Bland–Altman plot analysis were used to assess the relationships among these parameters within the entire cohort and across the 3 subgroups. <b>Results:</b> A strong correlation was found among the parameters across the 3 software programs. Groupwise comparison revealed that group 3 (EF &lt; 50%) exhibited the highest consistency in parameter agreement across software packages. EFs also showed good concordance with 2D echocardiography, particularly in group 3. Among the software packages, Myovation Evolution demonstrated the closest alignment with 2D echocardiography for EF assessment. <b>Conclusion:</b> Although the Emory Cardiac Toolbox, Cardiogam, and Myovation Evolution showed strong correlation among each other and with 2D echocardiography for several parameters, notable differences exist in their diagnostic accuracy and levels of automation. To address these differences, we recommend using the same software for myocardial perfusion quantification method when assessing patients over time or comparing results between them.