Comparative Definitions for Moderate-Severe Ischemia in Stress Nuclear, Echocardiography, and Magnetic Resonance Imaging

• Authors: Leslee Shaw, Emory University; Daniel S. Berman, Cedars-Sinai Medical Center; Michael H. Picard, Massachusetts General Hospital; Matthias G. Friedrich, Montreal Heart Institute; Raymond Y. Kwong, Brigham and Women’s Hospital; Gregg W. Stone, Columbia University; Roxy Senior, Imperial College London; James K. Min, Weill Cornell Medical College; Rory Hachamovitch, Cleveland Clinic Foundation; Marielle Scherrer-Crosbie, Massachusetts General Hospital; Jennifer H. Mieres, North Shore Long Island Jewish Hospital; Thomas H. Marwick, Menzies Research Institute of Tasmania; Lawrence M. Phillips, New York University; Farooq A. Chaudhry, cahn School of Medicine at Mount Sinai; Patricia A. Pellikka, Mayo Clinic; Piotr Slomka, Cedars-Sinai Medical Center; Andrew E. Arai, National Heart, Lung, and Blood Institute; Ami E. Iskandrian, University of Alabama Birmingham; Timothy M. Bateman, St. Luke’s Mid-America Heart Institute; Gary V. Heller, Hartford Hospital; Abhinav Goyal, Emory University
• Journal Title: JACC: Cardiovascular Imaging
• Volume: Volume 7, Number 6
• Publisher: Elsevier: 12 months | 2014-06-01, Pages 593-604
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jcmg.2013.10.021
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Radiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Radiology, Nuclear Medicine & Medical Imaging; Cardiovascular System & Cardiology; cardiac imaging; ischemia; prognosis; CORONARY-ARTERY-DISEASE; EMISSION COMPUTED-TOMOGRAPHY; VENTRICULAR EJECTION FRACTION; INCREMENTAL PROGNOSTIC VALUE; OPTIMAL MEDICAL THERAPY; MYOCARDIAL-PERFUSION SCINTIGRAPHY; AMERICAN-HEART-ASSOCIATION; EXERCISE ECHOCARDIOGRAPHY; RISK STRATIFICATION; REVASCULARIZATION PROCEDURES

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.