Vasodilator stress perfusion CMR for outcome prediction in patients under 45 years with suspected CAD

Although the prognostic value of vasodilator stress cardiovascular magnetic resonance (CMR) is established, it has never been assessed in patients <45 years with suspected coronary artery disease. The aim was to assess the long-term prognostic value of stress CMR to predict mortality in a multicenter cohort of patients <45 years-old.

Between December 2008 and December 2024, a prospective multicenter registry enrolled all consecutive patients undergoing vasodilator stress CMR at three French centers. For the present retrospective analysis, all patients aged <45 years were included. The primary endpoint was all-cause mortality, assessed through the French National Death Registry. Cox regression analyses were performed to determine the prognostic value of inducible ischemia and late gadolinium enhancement (LGE).

Of the 3,671 patients (mean age 38±6 years, 65% males), 102 (2.8%) died after a median follow-up of 6.8 years (interquartile range: 3-11 years). Annualized mortality rates increased gradually with the number of segments of ischemia and LGE (both p-trend<0.001). The extent of ischemia (hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.24-1.70) and LGE (HR: 1.56; 95% CI: 1.39-1.75) were both associated with mortality (both p<0.001). After adjustment for traditional prognostic factors, both the extent of ischemia (adjusted HR: 1.26, per 1-segment increase; 95% CI: 1.06-1.51, p=0.011) and LGE (adjusted HR: 1.50, per 1-segment increase; 95% CI: 1.25-1.80, p<0.001) remained independent predictors of mortality.

In patients <45 years undergoing stress CMR, the extent of both inducible ischemia and LGE provide strong and independent prognostic value for predicting all-cause mortality.