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

Area of Science:

• Cardiology
• Medical Imaging
• Clinical Risk Assessment

Background:

• Inconsistent reporting of ischemia magnitude on noninvasive imaging leads to variability in assessing severity across different stress modalities.
• Translating ischemia severity is crucial for accurate patient risk stratification and management decisions.

Purpose of the Study:

• To establish standardized risk thresholds for ischemia across stress nuclear imaging, stress echocardiography, and cardiac magnetic resonance imaging.
• To enable a common understanding of patient risk based on equivalent ischemia levels.

Main Methods:

• A narrative review of existing literature was conducted.
• Identified the risk threshold for coronary artery disease (CAD) death or myocardial infarction (MI) associated with ≥10% ischemic myocardium on stress nuclear imaging.
• Defined equivalent risk thresholds for stress echocardiography and cardiac magnetic resonance imaging.

Main Results:

• ≥10% ischemic myocardium on stress nuclear imaging correlated with a median CAD death or MI rate of 4.9% per year.
• ≥3 newly dysfunctional segments on stress echocardiography correlated with a median CAD death or MI rate of 4.5% per year.
• Moderate-to-severe ischemia on cardiac magnetic resonance imaging may be indicated by ≥4 perfusion defects or ≥3 dysfunctional segments.

Conclusions:

• Risk-based thresholds can define equivalent ischemia levels across stress imaging modalities.
• Standardized reporting enhances the translation of ischemia severity and patient risk.
• This facilitates consistent management decisions for patients with suspected or known coronary artery disease.