Incremental Prognostic Value of Subendocardial Myocardial Flow Reserve in Patients With Normal Perfusion
Main finding · MACEResult — go to the resultHazard ratio 1.41 95% CI 1.22–1.64Authors' conclusion
Subendocardial MFR reveals clinically meaningful risk heterogeneity among patients with preserved transmural flow reserve, helping refine risk stratification beyond traditional PET metrics.
Study context
- Population
- Patients with normal perfusion on stress/rest Rb-82 positron emission tomography (PET), excluding prior CABG, heart transplantation or LVEF <40%1,661 MACE events
- Participants
- 6,603 patients
- Exposure
- Discordant vs Concordant-normal
- Concordant-normaln = 4,103reference
- Discordantn = 885
- Abnormal MFRTMn = 1,615
- Outcome
- MACE:
- Death
- MI
- Revascularization
- HF hospitalization
- Follow-up
- Median 4.9 years
Methodological detailsmulticentre
- Multicentre
Main finding
MACE
Hazard ratio
1.41
95% CI 1.22–1.64
By group
Concordant-normal
3.99%
95% CI 3.67–4.30
Adjusted annualized MACE rate
Discordant
5.79%
95% CI 5.10–6.49
Adjusted annualized MACE rate
Abnormal MFRTM
8.35%
95% CI 7.71–9.00
Adjusted annualized MACE rate
Discordant vs Concordant-normal
HR 1.41 (95% CI 1.22–1.64)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortalityDiscordant vs Concordant-normal | 1.36 (1.14–1.61) | |
| 0.512Hazard ratio (log scale) |
Median
| Outcome | Concordant-normal | Discordant | Abnormal MFRTM |
|---|---|---|---|
| Transmural MFR | 2.86 | 2.15 | 1.72 |
Original publication
Incremental Prognostic Value of Subendocardial Myocardial Flow Reserve in Patients With Normal Perfusion. Circulation. Published 4 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it