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Stress CMR ischemic burden and long-term mortality in left ventricular systolic dysfunction: a multicenter registry
Alexandre Pfeffer1,2,3,4,5, Jérôme Garot3,5,6, Suzanne Duhamel5,6
1Université Paris Cité, Department of Cardiology, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010, Paris, France.
European Heart Journal. Cardiovascular Imaging
|July 21, 2026
Summary
Stress perfusion cardiovascular magnetic resonance (CMR) identifies myocardial ischemia, which independently predicts long-term mortality in patients with reduced left ventricular ejection fraction (LVEF). Integrating ischemia and scar imaging improves risk stratification for LV systolic dysfunction.
Area of Science:
- Cardiovascular Imaging
- Cardiac MRI
- Myocardial Perfusion Imaging
Background:
- Stress perfusion cardiovascular magnetic resonance (CMR) assesses myocardial ischemia, scar, and function.
- Its prognostic value in patients with left ventricular (LV) systolic dysfunction is not fully established.
Purpose of the Study:
- To evaluate the incremental prognostic value of inducible ischemia and late gadolinium enhancement (LGE) on stress perfusion CMR.
- To assess these markers in patients with LV systolic dysfunction (LVEF <50%).
Main Methods:
- Analysis of a prospective multicenter registry of 5,977 patients with LVEF <50% undergoing vasodilator stress perfusion CMR.
- Multivariable Cox models and reclassification metrics (NRI, IDI) assessed associations with all-cause mortality over 9 years.
- Evaluated incremental prognostic value beyond clinical factors and LVEF.
Main Results:
- Inducible ischemia was present in 19% of patients; ischemic segment extent independently predicted mortality (HR 1.11 per segment).
- Adding ischemia and LGE to clinical factors and LVEF significantly improved model fit and reclassification (p<0.001).
- Findings were consistent across LVEF subgroups (<40% and 40-50%).
Conclusions:
- Ischemic burden on stress-CMR is an independent predictor of long-term mortality in patients with LVEF <50%.
- Integrating ischemia and scar metrics provides incremental prognostic information for risk stratification.
- Stress-CMR aids risk stratification in LV systolic dysfunction.
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