Key result
Combined scar by LGE and fixed perfusion defect linked to ~5-fold higher MACE risk.
Why the study?
Data comparing myocardial scar detection by cardiovascular magnetic resonance late gadolinium enhancement (CMR-LGE) with fixed perfusion defects on nuclear myocardial perfusion imaging (MPI) are limited.
Does nuclear myocardial perfusion imaging accurately detect myocardial scar compared to CMR-LGE, and does the presence of scar on both modalities predict major adverse cardiovascular events?
Cohort (n=814)
No
Does nuclear myocardial perfusion imaging accurately detect myocardial scar compared to CMR-LGE, and does the presence of scar on both modalities predict major adverse cardiovascular events?
Hazard Ratio: 4.95 (95% CI 3.01–8.11)
p-value: p=<0.001
Nuclear myocardial perfusion imaging generally underestimates myocardial scar compared to CMR-LGE, but finding a scar on both modalities identifies a subset of patients at particularly high risk for adverse cardiovascular outcomes.
Combined scar on CMR-LGE and nuclear MPI was associated with higher MACE risk; leaves open whether dual-modality imaging improves risk stratification.
BACKGROUND: Cardiovascular magnetic resonance late gadolinium enhancement (CMR-LGE) is the reference standard for scar detection, but data comparing LGE with fixed perfusion defects (FPD) on nuclear myocardial perfusion imaging (MPI) are limited. OBJECTIVES: This study aimed to evaluate concordance between myocardial scar detection by CMR-LGE and nuclear MPI. METHODS: ) was determined for PET. Patients with myocardial infarction or revascularization between studies were excluded. Associations of LGE and FPD with major adverse cardiovascular events (MACE) were analyzed. RESULTS: (0.61 [0.53-0.68] vs 0.80 [0.74-0.85] mL/min/g; P < 0.001). Patients with both LGE and FPD had higher MACE risk than patients without these features (HR: 4.95 [95% CI: 3.01-8.11]; P < 0.001). CONCLUSIONS: MPI detected myocardial scar less frequently than CMR-LGE, with PET providing greater specificity than SPECT for ischemic and transmural scar. Combined LGE and FPD identified patients at highest risk of adverse outcomes, supporting PET MPI for myocardial scar characterization.
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Csécs et al. (2026) conducted a cohort in Patients requiring myocardial perfusion and viability assessment (n=814). Nuclear Myocardial Perfusion Imaging (SPECT or PET) vs. Patients without combined LGE and fixed perfusion defect was evaluated on Major adverse cardiovascular events (composite of all-cause death, myocardial infarction, or hospitalization for heart failure) (HR 4.95, 95% CI 3.01-8.11, p=<0.001). Combined myocardial scar detection by late gadolinium enhancement and fixed perfusion defect significantly increased the risk of major adverse cardiovascular events (HR 4.95).
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