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Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the
Harmony R Reynolds1, Courtney B Page2, Leslee J Shaw3
1Cardiovascular Clinical Research Center, Department of Medicine, NYU Grossman School of Medicine, New York, NY (H.R.R., L.P., S.B., J.S.H.).
Insights
Stress-induced ischemia severity showed a weak to moderate association with the extent of coronary artery disease (CAD) in patients with obstructive CAD. This relationship varied by stress testing method used.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Research
Background:
- The link between stress-induced ischemia and coronary artery disease (CAD) extent is complex, influenced by factors like stress intensity, testing methods, prior infarction, and microvascular function.
- Investigating this relationship is crucial for understanding and managing patients with obstructive CAD.
Purpose of the Study:
- To examine the association between ischemia severity on stress testing and the extent of anatomic CAD.
- To compare these associations across different stress testing modalities in patients with moderate to severe ischemia.
Main Methods:
- Utilized data from 3601 participants with both stress tests and coronary computed tomography angiography (CCTA).
- Stress tests included nuclear imaging, echocardiography, cardiac MRI, and exercise tolerance tests.
- Ischemia was categorized as severe, moderate, mild, or none; CAD extent/severity was based on the modified Duke prognostic index.
Main Results:
- A weak association (r=0.27) was found between overall ischemia severity and CAD extent/severity.
- The strength of association varied by modality: nuclear (r=0.40), cardiac MRI (r=0.31), exercise tolerance test (r=0.18), and echocardiography (r=0.15).
- Infarction extent showed a weak association with CAD extent/severity.
Conclusions:
- Ischemia severity on stress testing demonstrates weak to moderate associations with the anatomic extent of CAD.
- These findings are relevant for patients with moderate or severe ischemia and controlled symptoms.
Background:
The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.
Methods:
Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test. Among those with preserved renal function who underwent coronary computed tomography angiography, we examined relationships between ischemia and CAD by coronary computed tomography angiography, overall, and by stress test modality, regardless of subsequent randomization. Core laboratories categorized ischemia as severe, moderate, mild, or none, while the extent and severity of anatomic CAD were categorized based on the modified Duke prognostic index.
Results:
Among 3601 participants with interpretable stress tests and coronary computed tomography angiography, ischemia severity was weakly associated with CAD extent/severity (r=0.27), with modest variability in strength of association by modality: nuclear (n=1532; r=0.40), echocardiography (n=827; r=0.15), cardiac magnetic resonance imaging (n=108; r=0.31), and exercise tolerance test (n=1134; r=0.18). The extent of infarction on nuclear imaging and echocardiography was weakly associated with CAD extent/severity.
Conclusions:
Overall, ischemia severity on stress testing showed weak to moderate associations with the anatomic extent of CAD in this cohort with moderate or severe ischemia on local interpretation and controlled symptoms.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
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