(1) Background: The impact of imaging-derived
ischemia is still under debate and the role of stress perfusion cardiac magnetic resonance (spCMR) in non-high-risk patient still needs to be clarified. The aim of this study was to evaluate the impact of spCMR in a case series of stable long-standing chronic coronary syndrome (CCS) patients with
ischemia and no other risk factor. (2) Methods: This is a historical prospective study including 35 patients with history of long-standing CCS who underwent coronary CT angiography (CCTA) and additional
adenosine spCMR. Clinical and imaging findings were included in the analysis. Primary outcomes were HF (
heart failure) and all major
cardiac events (
MACE) including death from cardiovascular causes,
myocardial infarction, or hospitalization for
unstable angina, or resuscitated
cardiac arrest. (3) Results: Mean follow-up was 3.7 years (IQR: from 1 to 6). Mean ejection fraction was 61 ± 8%. Twelve patients (31%) referred primary outcomes. Probability of experiencing primary outcomes based on symptoms was 62% and increased to 67% and 91% when multivessel disease and
ischemia, respectively, were considered. Higher ischemic burden was predictive of
disease progression (OR: 1.59, 95%CI: 1.18-2.14; p-value = 0.002). spCMR model resulted non inferior to the model comprising all variables (4) Conclusions: In vivo spCMR-modeling including perfusion and strain anomalies could represent a powerful tool in long-standing CCS, even when conventional imaging predictors are missing.