Comparative definitions for moderate-severe ischemia in stress nuclear, echocardiography, and magnetic resonance imaging

Leslee J. Shaw, Daniel S. Berman, Michael H. Picard, Matthias G. Friedrich, Raymond Y. Kwong, Gregg W. Stone, Roxy Senior, James K. Min, Rory Hachamovitch, Marielle Scherrer-Crosbie, Jennifer H. Mieres, Thomas H. Marwick, Lawrence M. Phillips, Farooq A. Chaudhry, Patricia A. Pellikka, Piotr Slomka, Andrew E. Arai, Ami E. Iskandrian, Timothy M. Bateman, Gary V. HellerTodd D. Miller, Eike Nagel, Abhinav Goyal, Salvador Borges-Neto, William E. Boden, Harmony R. Reynolds, Judith S. Hochman, David J. Maron, Pamela S. Douglas

Research output: Contribution to journalReview article

103 Scopus citations

Abstract

The lack of standardized reporting of the magnitude of ischemia on noninvasive imaging contributes to variability in translating the severity of ischemia across stress imaging modalities. We identified the risk of coronary artery disease (CAD) death or myocardial infarction (MI) associated with ≥10% ischemic myocardium on stress nuclear imaging as the risk threshold for stress echocardiography and cardiac magnetic resonance. A narrative review revealed that ≥10% ischemic myocardium on stress nuclear imaging was associated with a median rate of CAD death or MI of 4.9%/year (interquartile range: 3.75% to 5.3%). For stress echocardiography, ≥3 newly dysfunctional segments portend a median rate of CAD death or MI of 4.5%/year (interquartile range: 3.8% to 5.9%). Although imprecisely delineated, moderate-severe ischemia on cardiac magnetic resonance may be indicated by ≥4 of 32 stress perfusion defects or ≥3 dobutamine-induced dysfunctional segments. Risk-based thresholds can define equivalent amounts of ischemia across the stress imaging modalities, which will help to translate a common understanding of patient risk on which to guide subsequent management decisions.

Original languageEnglish (US)
Pages (from-to)593-604
Number of pages12
JournalJACC: Cardiovascular Imaging
Volume7
Issue number6
DOIs
StatePublished - Jun 2014

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Keywords

  • cardiac imaging
  • ischemia
  • prognosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Shaw, L. J., Berman, D. S., Picard, M. H., Friedrich, M. G., Kwong, R. Y., Stone, G. W., Senior, R., Min, J. K., Hachamovitch, R., Scherrer-Crosbie, M., Mieres, J. H., Marwick, T. H., Phillips, L. M., Chaudhry, F. A., Pellikka, P. A., Slomka, P., Arai, A. E., Iskandrian, A. E., Bateman, T. M., ... Douglas, P. S. (2014). Comparative definitions for moderate-severe ischemia in stress nuclear, echocardiography, and magnetic resonance imaging. JACC: Cardiovascular Imaging, 7(6), 593-604. https://doi.org/10.1016/j.jcmg.2013.10.021