Risk stratification remains a central objective in stress perfusion cardiac magnetic resonance (CMR) imaging. A study in European Heart Journal – Cardiovascular Imaging demonstrates that quantitative dual-sequence acquisition provides more accurate prognostic information than the dual-bolus approach.

This investigation included 570 adults undergoing coronary assessment. Both techniques were performed in the same examination, and clinical outcomes were independently adjudicated. Stress MBF and MPR were quantified. The primary endpoint was a composite of major adverse cardiovascular events, including acute coronary syndrome, stroke, heart failure hospitalization, late revascularization, and all-cause death. The median follow-up was 743 days, during which 54 events occurred.

Univariate Cox modeling showed significant associations with outcomes for all perfusion variables. In multivariable analysis, dual-sequence stress MBF (hazard ratio 0.35, 95 percent confidence interval 0.23 to 0.53) and dual-sequence MPR (hazard ratio 0.23, 95 percent confidence interval 0.15 to 0.36) remained independent predictors of major events. Dual-bolus MPR also retained significance but demonstrated weaker effect size. Harrell’s C-index indicated superior prognostic discrimination for dual-sequence measurements, with statistically significant improvements compared with dual-bolus values.

These results support dual-sequence quantitative stress perfusion as the preferred approach where available, given its enhanced ability to stratify cardiovascular risk and guide clinical decision-making.