Long-Term Prognostic Impact of Stress-Induced Myocardial Perfusion Abnormalities by Cardiac Magnetic Resonance According to Chest Pain Status in Patients Without Significant Epicardial Coronary Artery Disease

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected myocardial ischemia without significant epicardial coronary artery disease (n=597). Intervention: Stress-induced myocardial perfusion abnormalities (MPA) on CMR vs. Absence of stress-induced myocardial perfusion abnormalities (MPA). Primary outcome: All-cause death in patients with chest pain (HR 2.44, 95% CI 1.03-5.74, p=0.04).

Q: What does this research mean for the field?

In patients without significant epicardial coronary artery disease, stress-induced myocardial perfusion abnormalities on CMR independently predict increased long-term all-cause mortality in patients with chest pain, but not in those without chest pain. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yosuke Kirii; Tairo Kurita; Ryosuke Rakuka; Masaki Ishiyama; Akihiro Takasaki; Satoshi Nakamura; Masaki Ishida; Kakuya Kitagawa; Hajime Sakuma; Kaoru Dohi

doi:10.1253/circrep.cr-26-0284

November 10, 2026Circulation ReportsOpen Access

Long-Term Prognostic Impact of Stress-Induced Myocardial Perfusion Abnormalities by Cardiac Magnetic Resonance According to Chest Pain Status in Patients Without Significant Epicardial Coronary Artery Disease

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Key result

Stress-induced MPA on CMR is linked to ~2.4-fold higher mortality in patients with chest pain.

HR 2.44
95% CI 1.03-5.74
P=0.04
n=597

Why the study?

The prognostic significance of stress-induced myocardial perfusion abnormalities detected by CMR in patients without significant epicardial CAD, particularly according to chest pain status, remained unclear.

Does the presence of stress-induced myocardial perfusion abnormalities detected by cardiac magnetic resonance predict all-cause mortality according to chest pain status in patients without significant epicardial coronary artery disease?

Key Points

To evaluate the long-term prognostic significance of stress-induced myocardial perfusion abnormalities detected by cardiac magnetic resonance according to chest pain status in patients without significant epicardial coronary artery disease.
Single-center retrospective observational study of 597 patients without significant coronary artery disease undergoing adenosine triphosphate stress perfusion cardiac magnetic resonance between May 2008 and July 2023 at Mie University Hospital.
Patients were categorized by chest pain status into groups without chest pain (n=348: 320 without perfusion abnormalities, 28 with abnormalities) and with chest pain (n=249: 225 without abnormalities, 24 with abnormalities).
Clinical outcomes including all-cause death, major adverse cardiac and cerebrovascular events, and hard cardiovascular events were tracked over a median follow-up of 8.6 years (8.1 years for asymptomatic and 9.7 years for symptomatic cohorts).
In patients with chest pain, all-cause mortality was significantly higher in those with myocardial perfusion abnormalities compared to those without (7 deaths vs 21 deaths; P<0.01).
In patients without chest pain, all-cause mortality showed no significant difference between those with and without perfusion abnormalities (2 deaths vs 38 deaths; P=0.54).
No significant differences were observed between patients with and without perfusion abnormalities for major adverse cardiac and cerebrovascular events (P=0.99) or hard cardiovascular events (P=0.58) in the asymptomatic cohort.

Study Design

Type

Observational (n=597)

Multicenter

No

Structured PICO

Does the presence of stress-induced myocardial perfusion abnormalities detected by cardiac magnetic resonance predict all-cause mortality according to chest pain status in patients without significant epicardial coronary artery disease?

P

Population

597 adult patients (mean age 63.4 years, 45.9% female) without significant epicardial coronary artery disease or late gadolinium enhancement undergoing stress perfusion CMR, followed for a median of 8.6 years.

E

Exposure

Presence of stress-induced myocardial perfusion abnormalities (MPA) detected by stress perfusion cardiac magnetic resonance (CMR) using adenosine triphosphate infusion (160 μg/kg/min) and gadoterate meglumine (0.03 mmol/kg), stratified by chest pain status (n=28 without chest pain and with MPA; n=24 with chest pain and with MPA).

C

Comparator

Absence of stress-induced myocardial perfusion abnormalities (MPA) on stress perfusion CMR, stratified by chest pain status (n=320 without chest pain and without MPA; n=225 with chest pain and without MPA).

O

Outcome

All-cause death over a median follow-up of 8.6 years (8.1 years in patients without chest pain, 9.7 years in patients with chest pain).hard clinical

Main Result

Hazard Ratio: 2.44 (95% CI 1.03–5.74)

Absolute Event Rate: 29.2% vs 9.3%

p-value: p=0.04

In patients without significant epicardial coronary artery disease or myocardial scar, stress-induced myocardial perfusion abnormalities on CMR predict higher long-term all-cause mortality in symptomatic patients with chest pain, but not when detected incidentally in patients without chest pain.

Limitations

Single-center, retrospective observational design with potential residual confounding
Relatively small number of patients with MPA and clinical events, limiting statistical power
Qualitative rather than quantitative assessment of MPA
Chest pain status was determined retrospectively from clinical records and may be subject to misclassification
Only patients with renal function adequate for contrast-enhanced CMR were included
Detailed information regarding medical therapy was not uniformly available
Changes in MRI equipment and imaging protocols over the 15-year study period
Single-center, retrospective observational study with potential residual confounding
Qualitative rather than quantitative assessment of MPA, which may reduce sensitivity to subtle ischemic changes and is subject to artifacts or misclassification
Chest pain status determined from clinical records, subject to misclassification
Only included patients with adequate renal function for contrast-enhanced CMR, limiting generalizability
Uniform data on medical therapy was not available
Changes in MRI equipment and imaging protocols over the >15-year study period

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Implication

May aid risk stratification in symptomatic patients without obstructive CAD; leaves open prognostic value of stress-induced MPA on CMR in asymptomatic individuals.

Abstract

Background: The prognostic significance of stress-induced myocardial perfusion abnormalities (MPA) detected by cardiac magnetic resonance (CMR) has been reported in patients with coronary artery disease (CAD), but the clinical significance of these abnormalities in patients without significant CAD remains unclear, particularly with respect to chest pain status. In this study we investigated the long-term prognostic impact of stress-induced MPA by CMR according to chest pain status.

Discussion

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Cite This Study

Kirii et al. (2026) conducted an observational in Suspected myocardial ischemia without significant epicardial coronary artery disease (n=597). Stress-induced myocardial perfusion abnormalities (MPA) on CMR vs. Absence of stress-induced myocardial perfusion abnormalities (MPA) was evaluated on All-cause death in patients with chest pain (HR 2.44, 95% CI 1.03-5.74, p=0.04). Stress-induced MPA on CMR independently predicted higher all-cause mortality in patients with chest pain, but not in those without chest pain.

synapsesocial.com/papers/6af5cd26a40bbe8669e89b91 https://doi.org/10.1253/circrep.cr-26-0284

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Long-Term Prognostic Impact of Stress-Induced Myocardial Perfusion Abnormalities by Cardiac Magnetic Resonance According to Chest Pain Status in Patients Without Significant Epicardial Coronary Artery Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Long-Term Prognostic Impact of Stress-Induced Myocardial Perfusion Abnormalities by Cardiac Magnetic Resonance According to Chest Pain Status in Patients Without Significant Epicardial Coronary Artery Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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