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

journal contribution
posted on 2023-05-18, 01:34 authored by Shaw, LJ, Berman, DS, Picard, MH, Friedrich, MG, Kwong, RY, Stone, GW, Senior, R, Min, JK, Hachamovitch, R, Scherrer-Crosbie, M, Mieres, JH, Thomas MarwickThomas Marwick, Phillips, LM, Chaudhry, FA, Pellikka, PA, Slomka, P, Arai, AE, Iskandrian, AE, Bateman, TM, Heller, GV, Miller, TD, Nagel, E, Goyal, A, Borges-Neto, S, Boden, WE, Reynolds, HR, Hochman, JS, Maron, DJ, Douglas, PS
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.


Publication title

JACC: Cardiovascular Imaging










Menzies Institute for Medical Research


Elsevier Inc.

Place of publication

United States

Rights statement

Copyright 2014 Elsevier

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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