title: Comparative definitions for moderate-severe ischemia in stress nuclear, echocardiography, and magnetic resonance imaging.
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.
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia. Electronic address: lshaw3@emory.edu.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Department of Medicine, Division of Cardiac Imaging/Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.affiliation: Department of Medicine, Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Matthias G
authors.initials: MG
authors.lastname: Friedrich
authors.affiliation: Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Department of Cardiovascular Medicine, Division of Cardiology, Imperial College London, London, United Kingdom.
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
authors.affiliation: Department of Cardiovascular Medicine, Division of Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Department of Cardiovascular Medicine, Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
authors.affiliation: Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Marielle
authors.initials: M
authors.lastname: Scherrer-Crosbie
authors.affiliation: Department of Medicine, Division of Cardiology, North Shore Long Island Jewish Hospital, Manhasset, New York.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Mieres
authors.affiliation: Department of Medicine, Division of Cardiology, Menzies Research Institute of Tasmania, Hobart, Australia.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.affiliation: Department of Medicine, Division of Cardiology, New York University Medical Center, New York, New York.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Phillips
authors.affiliation: Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Farooq A
authors.initials: FA
authors.lastname: Chaudhry
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Department of Medicine, Division of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Piotr
authors.initials: P
authors.lastname: Slomka
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Arai
authors.affiliation: Department of Radiology, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.affiliation: Department of Medicine, Division of Cardiology, St. Luke's Mid-America Heart Institute, Kansas City, Missouri.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Bateman
authors.affiliation: Hartford Hospital, Hartford, Connecticut.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Heller
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Todd D
authors.initials: TD
authors.lastname: Miller
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, King's College London, London, United Kingdom.
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Department of Nuclear Medicine, Division of Radiology, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Salvador
authors.initials: S
authors.lastname: Borges-Neto
authors.affiliation: Department of Medicine, Division of Cardiology, Samuel S. Stratton VA Medical Center, Albany, New York.
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.affiliation: Department of Medicine, Division of Cardiology, New York University Medical Center, New York, New York.
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.affiliation: Department of Medicine, Division of Cardiology, New York University Medical Center, New York, New York.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.affiliation: Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000465:Algorithms; D025401:Echocardiography, Stress; D006801:Humans; D008279:Magnetic Resonance Imaging; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: cardiac imaging; ischemia; prognosis