Abstract Background and aim Vasodilator stress perfusion cardiovascular magnetic resonance (CMR) has demonstrated good diagnostic performance for detecting obstructive coronary artery disease (CAD), but its prognostic value is sometimes regarded as less well established compared with other imaging modalities. The aim of this study was to assess the prognostic value of stress CMR in a contemporary cohort of patients with known or suspected CAD. Methods Consecutive patients undergoing adenosine stress perfusion CMR on a 1.5T scanner between 2019 and 2023 were followed for the occurrence of major adverse events, defined as all-cause mortality, non-fatal myocardial infarction (MI), cardiovascular hospitalization and late coronary revascularization (12 months post-CMR). The primary endpoint was defined as the composite of all-cause death and non-fatal MI. Secondary outcomes were defined as the occurrence of each individual major event. Survival analysis was performed to determine the prognostic value of inducible myocardial ischemia (≥2 segments) and late gadolinium enhancement (LGE) with ischemic pattern. Results A total of 1043 patients (66% male; mean age 68 ± 11 years) were analyzed. Among them, 46.5% (n = 485) had known CAD, including 28.8% (n = 300) with previous MI, 29.2% (n = 305) with prior percutaneous coronary intervention (PCI), and 11.7% (n = 122) with prior coronary artery bypass grafting (CABG). Stress CMR was positive for ischemia in 268 patients (24.7%) and showed ischemic LGE in 426 (40.8%). A total of 157 patients (15.1%) had both inducible ischemia and ischemic LGE. Non-ischemic LGE was incidentally detected in 278 cases (26.6%). Over a median follow-up of 2.9 years, 215 events (20.6%) were recorded (84 deaths, 33 non-fatal MI’s, 81 cardiovascular hospitalizations and 17 late revascularizations). Survival analysis showed significantly higher risks for the primary composite endpoint in patients with inducible ischemia, ischemic LGE, or both – Figure 1. Prognostic significance was consistent across each individual event analyzed (all log-rank p 0.001). Multivariable Cox regression identified age (HR 1.05, 95% CI 1.03–1.07, p 0.001), LV ejection fraction (HR 0.97, 95% CI 0.96–0.99, p 0.001), inducible ischemia (HR 1.59, 95%CI 1.09–2.32, p = 0.015) and ischemic LGE (HR 1.70, 95%CI 1.07–2.69, p = 0.024) as independent predictors of the primary endpoint. Conclusion Both ischemia and ischemic LGE detected by stress perfusion CMR are significantly associated with an increased risk of the primary composite outcome of death and non-fatal MI. These findings confirm the prognostic value of stress perfusion CMR and support its application in routine clinical practice.
Domingues et al. (2025) studied this question.