FOCUS-ischemia: A real-world comparison of an ischemia-focused analytical strategy and conventional multiparametric stress CMR

Background Stress cardiovascular magnetic resonance (CMR) provides comprehensive assessment of myocardial ischemia and myocardial scar but remains limited by examination duration and accessibility. Whether an ischemia-focused analytical strategy preserves clinically relevant information compared with conventional multiparametric stress CMR remains uncertain. Objectives To compare the real-world performance of an ischemia-focused analytical strategy (FOCUS-Ischemia) with conventional multiparametric stress CMR for prediction of downstream coronary management and clinical outcomes. Methods A total of 717 consecutive patients undergoing clinically indicated stress CMR in the Nancy Ischemia Registry were included. Patients were stratified according to inducible ischemia and late gadolinium enhancement (LGE). Endpoints included early coronary revascularization within 30 days, late revascularization >30 days, and a composite outcome including death, unplanned invasive coronary angiography , or coronary revascularization. ROC, Kaplan–Meier, and multivariable Cox analyses were performed. Results Inducible ischemia was strongly associated with downstream coronary management and adverse outcomes. Early revascularization rates were markedly higher in ischemic versus non-ischemic patients (18.1% and 17.0% vs 0.0% and 0.5%; p < 0.001). The FOCUS-Ischemia and multiparametric stress CMR models demonstrated similar discriminatory performance for early revascularization (AUC 0.880 vs 0.885), late revascularization (0.746 vs 0.748), and the composite clinical endpoint (0.819 vs 0.821). Conclusions An ischemia-focused analytical strategy derived from a conventional multiparametric stress CMR examination demonstrated similar discriminatory performance for coronary management-related outcomes. Because all patients underwent a conventional multiparametric stress CMR examination, the present study did not evaluate an abbreviated acquisition protocol. These findings should therefore be considered exploratory and hypothesis-generating.