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Final Program


Program-At-A-Glance

Oral Abstracts Session

Virtual Recording

Session: Oral Abstracts Clinical Session 3

Long-term prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance in young patients <45 years

Friday, February 6, 2026
10:00 AM - 10:10 AM  
Location: Asia IV and Hall 8 (3rd Floor)
Background: Benefit of screening coronary artery disease (CAD) using stress perfusion cardiovascular magnetic resonance (CMR) in young patients < 45 years is not well established. The aim of our study was to assess the long-term prognostic value of vasodilator stress CMR in young patients < 45 years.

Methods: Between December 2008 and January 2024, all consecutive young patients < 45 years referred for stress CMR to three tertiary French centers were included. The primary endpoint was all-cause mortality defined by the French National Electronic Death Registry (INSEE). Cox regressions were performed to determine the prognostic value of each clinical and CMR parameter.

Results: Among 61,234 patients referred for vasodilator stress perfusion CMR due to suspected or known CAD, 3,671 (6%) were aged < 45 years and constituted the final cohort. Among these 3,671 young patients (38±6 years; 65% male) 102 died (2.8%) after a median [IQR] follow up of 6.8 [3.0-11] years. Annualized rates of mortality increased with ischemia extent: 0.3%/year for 1-2 segments, 1.7%/year for 3-5 segments, and 4.1%/year for ≥5 segments (p-trend< 0.001). Similar gradients were observed across LGE segments categories (p-trend< 0.001). Using survival analysis, the presence of both ischemia and LGE were associated with all-cause death (HR 2.28; 95% CI 1.33-2.89; and HR 1.13; 95% CI 2.07-4.72; both p< 0.001) (Figure 1). Consistently, the number of ischemic segments was associated with all-cause death (HR 1.45; 95% CI 1.24-1.70; p< 0.001), as was the number of LGE segments (HR 1.56; 95% CI 1.39-1.75; p< 0.001). Interestingly, the presence of ischemia was associated with mortality to a similar extent in both symptomatic and asymptomatic patients (Figure 2). This association remained significant after adjustment for all traditional prognostic factors (including age, diabetes, hypertension, dyslipidemia, current smoking, known CAD, LVEF and LGE): each additional ischemic segment was associated with adjusted HR 1.26 (95% CI 1.06-1.51; p=0.011).

Conclusion: Using the largest cohort of young patients < 45 years referred for stress CMR, the presence and extent of both inducible ischemia and LGE were strong long-term independent predictors of all-cause mortality even after adjustment for all known prognostic factors.

Table 1. Univariable and multivariable analysis of clinical and cardiovascular magnetic resonance characteristics for prediction of all-cause death (Nf3671)

 

 

 

Univariable analysis

 

Multivariable analysis

 

Hazard Ratio (95% CI)

p value

 

Hazard Ratio (95% CI)

p value

 

Age

1.07 (1.02-1.11)

0.002

 

1.05 (1.00-1.09)

0.031

 

Male

1.05 (0.69-1.60)

0.83

 

0.95 (0.62-1.47)

0.82

 

Diabetes

1.70 (1.02-2.83)

0.042

 

1.38 (0.79-2.40)

0.25

 

Dyslipidemia

1.26 (0.83-1.91)

0.27

 

0.93 (0.60-1.45)

0.76

 

HTA

1.62 (1.08-2.44)

0.021

 

1.30 (0.84-2.03)

0.24

 

BMI

1.01 (0.98-1.04)

0.48

 

0.98 (0.94-1.02)

0.28

 

Known CAD

2.01 (1.31-3.08)

0.001

 

0.53 (0.29-0.98)

0.041

 

Current smoking

1.79 (1.20-2.65)

0.004

 

1.64 (1.10-2.47)

0.016

 

Family history of CAD

1.11 (0.74-1.68)

0.60

 

0.99 (0.65-1.50)

0.94

 

LVEF (per 5-unit increase)

0.70 (0.64-0.77)

< 0.001

 

0.77 (0.68-0.87)

< 0.001

 

LVEDVi (per 10-unit increase)

1.10 (1.01-1.21)

0.034

 

0.93 (0.84-1.04)

0.20

 

Number of LGE segments

1.56 (1.39-1.75)

< 0.001

 

1.50 (1.25-2.80)

< 0.001

 

Number of ischemia segments

1.45 (1.24-1.70)

< 0.001

 

1.26 (1.06-1.51)

0.011

Table 2. Multivariable analysis of clinical and cardiovascular magnetic resonance characteristics for the prediction of all-cause death (Nf3671) using stepwise backward feature selection.

 

 

HR

95% CI

p-value

Age

1.04 (1.00-1.09)

0.039

History of MI

0.60 (0.32-1.13)

0.12

Renal failure†

4.80 (1.73-13.32)

0.003

Stress CMR indication: high CV risk

1.48 (0.94-2.33)

0.09

LVEDV (per 10-unit increase)

1.11 (1.05-1.17)

< 0.001

LV systolic ejection volume index

0.97 (0.96-0.99)

< 0.001

Number of ischemic segments

1.26 (1.06-1.50)

0.008

Number of LGE segments

1.42 (1.20-1.68)

< 0.001

Current smoking

1.72 (1.16-2.57)

0.007

†defined by glomerular filtration rate < 60 ml/min/1.73 m2

 

 


Figure 1. Risk curves of all-cause mortality stratified by the presence of ischemia in young patients < 45 years.
Figure 2. Risk curves of all-cause mortality stratified by the presence of ischemia in symptomatic and asymptomatic.
Forest plot of all-cause mortality across subgroups