Eur Heart J Cardiovasc Imaging. 2026 Jul 21:jeag189. doi: 10.1093/ehjci/jeag189. Online ahead of print.
ABSTRACT
BACKGROUND: Stress perfusion cardiovascular magnetic resonance (CMR) integrates assessment of myocardial ischemia, scar, and function. Its incremental prognostic value in patients with left ventricular (LV) systolic dysfunction remains uncertain.
METHODS: We analyzed a prospective multicenter registry of consecutive patients undergoing vasodilator stress perfusion CMR at three French centers (2008-2024). Patients with CMR-derived LVEF <50% were included. The primary end point was all-cause mortality. Associations were estimated with multivariable Cox models. Incremental prognostic value of ischemia and late gadolinium enhancement (LGE) beyond clinical factors and LVEF was assessed by likelihood-ratio χ2, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
RESULTS: Among 5,977 patients (79% men; age 66±12 years, mean LVEF 42±7%), inducible ischemia was present in 19% (mean extent 2.4±1.2 segments). Over a median follow-up of 9 years, 1,343 patients (22%) died. Ischemic segment extent was independently associated with mortality (HR per segment 1.11; 95% CI, 1.06-1.15; p<0.001). Adding ischemia and LGE to clinical factors and LVEF improved model fit and reclassification (global χ2 increased from 707 to 728; NRI 0.217; IDI 0.004; all p<0.001). Findings were consistent across LVEF subgroups (40-50% and <40%). In secondary analyses among patients with ischemia, outcomes differed by subsequent revascularization status; these findings are observational and hypothesis-generating.
CONCLUSIONS: In patients with LVEF <50%, ischemic burden on stress-CMR is independently associated with long-term mortality beyond clinical factors, LVEF and LGE. Integrating ischemia and scar metrics provides incremental prognostic information that may aid risk stratification using stress-CMR in LV systolic dysfunction.
PMID:42478870 | DOI:10.1093/ehjci/jeag189