Safety and prognostic value of vasodilator stress cardiovascular magnetic resonance in patients with heart failure and reduced ejection fraction (HFrEF)

Background Recent data suggest that patients with HFrEF [heart failure with reduced left ventricular ejection fraction (LVEF)  Purpose To assess the safety and the prognostic value of vasodilator stress perfusion CMR in patients with HFrEF. Methods Between 2008 and 2018, we prospectively included consecutive patients with HFrEF defined by LVEF  Results Of 1084 patients with HFrEF (65 ± 11 years, median LVEF 34.6 ± 4.9%), 1049 (97%) completed the CMR protocol and among those 952 (91%) completed the follow-up (median 5.6 ± 2.4 years). Stress CMR was well tolerated without severe adverse event. Using Kaplan–Meier analysis, the presence of inducible ischemia and LGE were significantly associated with the occurrence of MACE (hazard ratio [HR]: 2.46 [95% CI: 1.69–3.59]; P  Fig. 1 ). In multivariable stepwise Cox regression including clinical characteristics and CMR, the inducible ischemia was an independent predictor of a higher incidence of MACE at follow-up (adjusted HR: 2.26 [95% CI: 1.52–3.35]; P  Conclusions Stress CMR is safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients with HFrEF.