Open Heart. 2026 Jun 8;13(1):e004086. doi: 10.1136/openhrt-2026-004086.
ABSTRACT
BACKGROUND: Prior studies have shown that a supranormal range of left ventricular ejection fraction (LVEF) is associated with adverse cardiovascular outcomes. However, the prognostic value of stress perfusion cardiac magnetic resonance (CMR) in patients with supranormal LVEF is not well defined. This study aimed to assess the prognostic significance of stress perfusion CMR in patients with known or suspected coronary artery disease and supranormal LVEF.
METHODS: This cohort study included patients aged ≥18 years who underwent clinical stress perfusion CMR at an academic hospital in Thailand between 2011 and 2022 and had an LVEF ≥65% on CMR. Patients were divided into two groups based on the presence of myocardial ischaemia on CMR and were followed for major adverse cardiovascular events (MACE), defined as a composite of all-cause death, acute coronary syndrome (ACS) or hospitalisation for heart failure.
RESULTS: A total of 531 patients were included (mean age 68.7±11.0 years; 42.6% male; mean LVEF 75.1%±6.2%). Myocardial ischaemia was detected in 124 patients. During a median follow-up of 5.4 years (IQR, 2.1-9.5), 63 MACE occurred. Patients with myocardial ischaemia had a significantly higher rate of MACE than those without ischaemia (3.71 vs 1.74 per 100 patient-years; HR 2.13; 95% CI 1.28 to 3.54; p=0.004). In multivariable Cox regression analysis, myocardial ischaemia remained independently associated with MACE (HR 1.81; 95% CI 1.08 to 3.05; p=0.02). The prognostic value of myocardial ischaemia was consistent across LVEF tertiles (p for interaction=0.79). Other independent predictors included age (HR 1.03; 95% CI 1.001 to 1.05; p=0.03), a history of heart failure (HR 2.65; 95% CI 1.57 to 4.46; p<0.001) and LV mass index (HR 1.03; 95% CI 1.02 to 1.04; p<0.001).
CONCLUSIONS: In patients undergoing stress perfusion CMR with supranormal LVEF, myocardial ischaemia detected by CMR provided significant prognostic value for predicting a composite of all-cause death, ACS or hospitalisation for heart failure.
PMID:42259583 | DOI:10.1136/openhrt-2026-004086