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Stress CMR ischaemic burden and long-term mortality in left ventricular systolic dysfunction: a multicentre 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), Paris 75010, France.

European Heart Journal. Cardiovascular Imaging
|July 21, 2026
PubMed

Insights

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.
Abstract

Keywords:
cardiovascular magnetic resonancecoronary artery diseaseheart failurelate gadolinium enhancementleft ventricular dysfunctionmyocardial ischaemia

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