SPC365

Prognostic value of stress perfusion CMR in patients without known coronary artery disease: a real-world single-center experience

Session: Sessão de Comunicações Orais 16 – Imagiologia avançada para estratificação de risco: do ECV à RMC em contexto de vida real
Speaker: Márcia Presume

Congress: CPC 2026
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.3 Cardiac Magnetic Resonance
Session Type: Comunicações Orais
FP Number: ---
Authors: Márcia Presume; Miguel Domingues; Rui Miguel Gomes; André Garcia; Catarina Santos-Jorge; Pedro Lopes; Francisco Gama; Cláudia Silva; Sara Guerreiro; João Abecasis; Pedro Freitas; António Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Background and aim: </span></span></strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Stress perfusion cardiovascular magnetic resonance (CMR) is widely used to assess myocardial ischemia, yet its prognostic evidence&mdash;particularly in patients without known coronary artery disease (CAD)&mdash;is less extensive than that of older imaging modalities. We aimed to evaluate the prognostic value of stress CMR in a contemporary cohort of patients without known CAD.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Methods: </span></span></strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">We conducted a single-center retrospective study including </span></span><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">patients without known CAD who underwent adenosine stress CMR on a 1.5-T system between 2019 and 2023. Major adverse cardiovascular events (MACE), defined as all-cause death, non-fatal myocardial infarction (MI), cardiovascular hospitalization and late coronary revascularization, were recorded as the primary endpoint. Secondary outcomes were defined as each individual component of the composite endpoint.</span> <span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">The prognostic value of inducible myocardial ischemia (&ge;2 segments) and ischemic-pattern late gadolinium enhancement (LGE) (previously unknown myocardial infarction) was evaluated using survival and Cox regression analyses.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Results: </span></span></strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">A total of 558 patients were included (median age 68.7 years; 57.5% male).</span></span><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"> Patients showed a high cardiovascular risk burden, including </span><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">hypertension (73%), dyslipidaemia (65%), smoking (31%), diabetes mellitus (27%), chronic kidney disease (27%), and atrial fibrillation (22%).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Stress CMR was positive for inducible myocardial ischemia in 14.5% of patients and ischemic LGE in 15.8%, with 4.5% presenting both findings. Concomitant non-ischemic LGE was identified in 11.3%. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Over a median follow-up of 2.9 years, the primary endpoint ocorred in 16.3%. Survival analysis showed a higher incidence of the primary endpoint in patients with inducible ischemia, ischemic LGE, or both (log-rank p&lt;0.001). Increase in event rates was also observed for all-cause mortality (log-rank p=0.005), non-fatal MI (log-rank p=0.018), cardiovascular hospitalization (log-rank p=0.013) and </span></span><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">late coronary revascularization (log-rank p&lt;0.001) (figure 1).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">In multivariable Cox regression analysis, age (HR 1.03, 95% CI 1.01&ndash;1.04, p&lt;0.001), LV ejection fraction (HR 0.97, 95% CI 0.96&ndash;0.98, p&lt;0.001), inducible myocardial ischemia (HR 1.67, 95% CI 1.25&ndash;2.23, p&lt;0.001), and ischemic LGE (HR 1.66, 95% CI 1.24&ndash;2.23, p=0.001) were independent predictors of the primary endpoint.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><span style="color:black">Conclusion: </span></span></strong><span style="font-family:&quot;Arial&quot;,&quot;sans-serif&quot;">Stress CMR offers robust prognostic information in patients without known CAD. Inducible ischemia and ischemic LGE were independently associated with an increased risk of MACE. Importantly, stress CMR also revealed a substantial number of previously unrecognized MI, a finding with direct implications for patient management.</span></span></span></p>