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Comparative definitions for moderate-severe ischemia in stress nuclear, echocardiography, and Magnetic Resonance Imaging

Citation

Shaw, LJ and Berman, DS and Picard, MH and Friedrich, MG and Kwong, RY and Stone, GW and Senior, R and Min, JK and Hachamovitch, R and Scherrer-Crosbie, M and Mieres, JH and Marwick, TH and Phillips, LM and Chaudhry, FA and Pellikka, PA and Slomka, P and Arai, AE and Iskandrian, AE and Bateman, TM and Heller, GV and Miller, TD and Nagel, E and Goyal, A and Borges-Neto, S and Boden, WE and Reynolds, HR and Hochman, JS and Maron, DJ and Douglas, PS, for the National Institutes of Health/National Heart, Lung, and Blood Institute–Sponsored ISCHEMIA Trial Investigators, Comparative definitions for moderate-severe ischemia in stress nuclear, echocardiography, and Magnetic Resonance Imaging, JACC: Cardiovascular Imaging, 7, (6) pp. 593-604. ISSN 1936-878X (2014) [Refereed Article]

Copyright Statement

Copyright 2014 Elsevier

DOI: doi:10.1016/j.jcmg.2013.10.021

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.

Item Details

Item Type:Refereed Article
Keywords:cardiac imaging, ischemia, prognosis
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:92448
Year Published:2014
Web of Science® Times Cited:50
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-06-18
Last Modified:2017-10-31
Downloads:0

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