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February 14, 2026Open HeartOpen Access

Prognostic utility of stress perfusion cardiac magnetic resonance in patients with known or suspected coronary artery disease and inconclusive exercise stress testing

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Why the study?

Exercise stress testing yields inconclusive results in up to 20% of patients, and data on using stress perfusion CMR in this group are limited.

Does the presence of inducible myocardial ischaemia on stress perfusion CMR predict major adverse cardiovascular events in patients with known or suspected CAD and inconclusive exercise stress testing?

Population

414 consecutive patients with known or suspected CAD and inconclusive EST results

Comparison

Presence vs absence of inducible myocardial ischaemia on stress perfusion CMR

Design

Cohort study

Follow-up

Median 6.9 years

Key result

Myocardial ischaemia detected by stress perfusion CMR was an independent predictor of MACE compared to no ischaemia (HR 4.03; 95% CI 1.94 to 8.38; p<0.001).

Authors

NTNaroudol TanvisutYKYodying Kaolawanich

Discussion

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Overview

May refine risk stratification after inconclusive exercise tests; leaves open whether CMR-guided decisions improve outcomes.

Key Points

  • The study aims to evaluate the prognostic value of stress perfusion cardiac magnetic resonance in patients with inconclusive exercise stress testing results.
  • Included patients with known or suspected coronary artery disease and inconclusive exercise stress tests from 2009 to 2022.
  • Divided patients based on the presence of inducible myocardial ischaemia as determined by cardiac magnetic resonance.
  • Primary outcome measured was major adverse cardiovascular events (MACE) over a median follow-up of 6.9 years.
  • 32 patients (7.7%) experienced major adverse cardiovascular events during follow-up.
  • Patients with myocardial ischaemia had a higher annualised MACE rate (2.8 vs 0.8 per 100 patient-years, p<0.001).
  • Myocardial ischaemia was identified as an independent predictor of MACE with a hazard ratio of 4.03 (95% CI 1.94 to 8.38, p<0.001).

Study Design

Type

Cohort (n=414)

Structured PICO

Does the presence of inducible myocardial ischaemia on stress perfusion CMR predict major adverse cardiovascular events in patients with known or suspected CAD and inconclusive exercise stress testing?

P
Population
414 adults (aged ≥18 years) with known or suspected coronary artery disease (CAD) and inconclusive exercise stress testing (EST) results, mean age 63.6, 48.3% male, based in Thailand (single center). Key inclusion: referred for stress perfusion CMR within 6 months of EST.
I
Intervention
Presence of inducible myocardial ischaemia detected by stress perfusion cardiac magnetic resonance (CMR) using adenosine (140 mcg/kg/min) and gadolinium contrast
C
Comparator
Absence of inducible myocardial ischaemia on stress perfusion CMR
O
Outcome
Major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, acute coronary syndrome, hospitalisation for heart failure, and ischaemic stroke, assessed over a median follow-up of 6.9 yearscomposite

Main Result

Effect estimate: HR 4.03 (95% CI 1.94 to 8.38)

Absolute Event Rate: 2.8% vs 0.8%

p-value: p=<0.001

Stress perfusion CMR effectively stratifies long-term cardiovascular risk in patients with known or suspected CAD who have inconclusive exercise stress testing results.

Limitations

  • Retrospective design
  • Selection bias due to referrals based on clinician's judgement
  • Visual analysis of stress CMR without novel quantitative techniques
  • Lack of data on adequacy of medical therapy following stress CMR
  • Lack of data on prognostic impact of CMR-guided revascularisation

Cite This Study

Tanvisut et al. (2026) conducted a cohort in Known or suspected coronary artery disease with inconclusive exercise stress testing (n=414). Stress perfusion CMR with inducible myocardial ischaemia vs. Stress perfusion CMR without inducible myocardial ischaemia was evaluated on Major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, acute coronary syndrome, hospitalisation for heart failure, and ischaemic stroke (HR 4.03, 95% CI 1.94 to 8.38, p=<0.001). Myocardial ischaemia detected by stress perfusion CMR was an independent predictor of MACE compared to no ischaemia (HR 4.03; 95% CI 1.94 to 8.38; p<0.001).

synapsesocial.com/papers/699011812ccff479cfe5838ahttps://doi.org/10.1136/openhrt-2025-003623
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