Shaw Leslee J, Berman Daniel S, Picard Michael H, Friedrich Matthias G, Kwong Raymond Y, Stone Gregg W, Senior Roxy, Min James K, Hachamovitch Rory, Scherrer-Crosbie Marielle, Mieres Jennifer H, Marwick Thomas H, Phillips Lawrence M, Chaudhry Farooq A, Pellikka Patricia A, Slomka Piotr, Arai Andrew E, Iskandrian Ami E, Bateman Timothy M, Heller Gary V, Miller Todd D, Nagel Eike, Goyal Abhinav, Borges-Neto Salvador, Boden William E, Reynolds Harmony R, Hochman Judith S, Maron David J, Douglas Pamela S
Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia.
Department of Medicine, Division of Cardiac Imaging/Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
JACC Cardiovasc Imaging. 2014 Jun;7(6):593-604. doi: 10.1016/j.jcmg.2013.10.021.
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.
在无创成像中，对缺血程度缺乏标准化报告，这导致了在不同负荷成像模式下对缺血严重程度的解读存在差异。我们将负荷核素成像中≥10%缺血心肌相关的冠状动脉疾病（CAD）死亡或心肌梗死（MI）风险确定为负荷超声心动图和心脏磁共振成像的风险阈值。一项叙述性综述显示，负荷核素成像中≥10%缺血心肌与CAD死亡或MI的年中位发生率4.9%相关（四分位间距：3.75%至5.3%）。对于负荷超声心动图，≥3个新出现功能障碍节段预示着CAD死亡或MI的年中位发生率为4.5%（四分位间距：3.8%至5.9%）。尽管界定并不精确，但心脏磁共振成像中的中重度缺血可能表现为32个负荷灌注缺损中≥4个或≥3个多巴酚丁胺诱发的功能障碍节段。基于风险的阈值可以定义不同负荷成像模式下等量的缺血情况，这将有助于形成对患者风险的共同理解，从而指导后续的管理决策。
