{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:34:56Z","timestamp":1780486496707,"version":"3.54.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Quantitative stress perfusion (QP) cardiac magnetic resonance (CMR) can be performed using the dual sequence (DS) or dual bolus (DB) technique. DS does not require additional contrast and image acquisition but needs a research sequence. DB can be performed on all magnetic resonance imaging (MRI) scanners with standard perfusion sequences but requires additional contrast injection and image acquisition. Our aim was to compare the prognostic significance of DB and DS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>DB and DS were performed on the same patient and the same examination. Analysts were blinded to clinical outcomes. Stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were quantified. The primary outcome was a composite of major adverse cardiovascular events (MACE) comprising acute coronary syndrome, stroke, heart failure (HF) hospitalization, late revascularization, and all-cause death. 570 patients (mean age: 63.2 \u00b1 12.3 years; 61.2% male) were recruited. Median follow-up was 743 days; 54 events were documented. All QP CMR variables demonstrated significance in univariate Cox regression [DB stress MBF [HR = 0.53 (95%CI:0.35\u20130.78)], DB MPR [HR = 0.38 (95%CI:0.22\u20130.66)], DS stress MBF [HR = 0.27 (95%CI:0.18\u20130.40)] and DS MPR [HR = 0.19 (95%CI:0.13\u20130.29)]]. On multivariable Cox regression models, only DB MPR, DS MBF, and DS MPR remained significant for MACE (HR = 0.50 (95%CI:0.28\u20130.89), HR = 0.35 (95%CI:0.23\u20130.53); HR = 0.23 (95%CI 0.15\u20130.36), respectively). Harrell\u2019s C-index of DS MPR and DS stress MBF showed significantly better prognostication than their DB counterparts (P &amp;lt; 0.001 and P = 0.012, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this blinded comparison, DS stress MBF and MPR demonstrated better prognostication than DB stress MBF and MPR. Our findings support DS as the preferred approach where available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf339","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T13:10:08Z","timestamp":1764767408000},"page":"544-553","source":"Crossref","is-referenced-by-count":1,"title":["Comparing prognostic significance of dual bolus and dual sequence quantitative stress perfusion cardiac magnetic resonance"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1623-8216","authenticated-orcid":false,"given":"Kwan Ho","family":"Leung","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haonan","family":"Wang","sequence":"additional","affiliation":[{"name":"GE HealthCare , Waukesha, WI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eponine Kate","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parco","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsun Hei","family":"Sin","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper Chak Fung","family":"Yip","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romelie M","family":"Tuplano","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Man Vivian","family":"Tse","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheuk Nam Felix","family":"Kwan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6275-1147","authenticated-orcid":false,"given":"Eric Yuk Fai","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong ,","place":["Hong Kong SAR"]},{"name":"Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chor Cheung Frankie","family":"Tam","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Queen Mary Hospital ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwong Yue Eric","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Queen Mary Hospital ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Yu","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Medicine, Tseung Kwan O Hospital ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor King-Man","family":"Goh","sequence":"additional","affiliation":[{"name":"Hong Kong Sanatorium & Hospital ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad","family":"Werys","sequence":"additional","affiliation":[{"name":"Circle Cardiovascular Imaging Inc. , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall","family":"Stafford","sequence":"additional","affiliation":[{"name":"Circle Cardiovascular Imaging Inc. , Calgary, Alberta ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2745-3275","authenticated-orcid":false,"given":"Martin A","family":"Janich","sequence":"additional","affiliation":[{"name":"GE HealthCare , Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9533-3892","authenticated-orcid":false,"given":"Ming-Yen","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital , 102 Pokfulam Road ,","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"2026022618521947500_jeaf339-B1","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1016\/j.jcmg.2018.12.022","article-title":"Automated pixel-wise quantitative myocardial perfusion mapping by CMR to detect obstructive coronary artery disease and coronary microvascular dysfunction: validation against invasive coronary physiology","volume":"12","author":"Kotecha","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026022618521947500_jeaf339-B2","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1016\/j.jcmg.2024.07.023","article-title":"Myocardial blood flow quantification using stress cardiac magnetic resonance improves detection of coronary artery disease","volume":"17","author":"Wang","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026022618521947500_jeaf339-B3","first-page":"1282","article-title":"The prognostic significance of quantitative myocardial perfusion: an artificial intelligence-based approach using perfusion mapping","volume":"141","author":"Knott","year":"2020","journal-title":"Circulation"},{"key":"2026022618521947500_jeaf339-B4","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.jcmg.2017.07.022","article-title":"Prognostic value of quantitative stress perfusion cardiac magnetic resonance","volume":"11","author":"Sammut","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026022618521947500_jeaf339-B5","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.jacc.2021.12.037","article-title":"Quantitative myocardial perfusion predicts outcomes in patients with prior surgical revascularization","volume":"79","author":"Seraphim","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026022618521947500_jeaf339-B6","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1093\/eurheartj\/ehx001","article-title":"Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the PRognostic importance of MIcrovascular dysfunction in aortic stenosis (PRIMID AS) study","volume":"38","author":"Singh","year":"2017","journal-title":"Eur Heart J"},{"key":"2026022618521947500_jeaf339-B7","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.jcmg.2020.09.034","article-title":"Long-term prognosis of patients with coronary microvascular disease using stress perfusion cardiac magnetic resonance","volume":"14","author":"Zhou","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026022618521947500_jeaf339-B8","doi-asserted-by":"crossref","first-page":"524","DOI":"10.3390\/diagnostics13030524","article-title":"Qualitative and quantitative stress perfusion cardiac magnetic resonance in clinical practice: a comprehensive review","volume":"13","author":"Zhou","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"2026022618521947500_jeaf339-B9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12968-017-0355-5","article-title":"Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification","volume":"19","author":"Kellman","year":"2017","journal-title":"J Cardiovasc Magn Reson"},{"key":"2026022618521947500_jeaf339-B10","doi-asserted-by":"crossref","first-page":"101940","DOI":"10.1016\/j.jocmr.2025.101940","article-title":"SCMR expert consensus statement on quantitative myocardial perfusion cardiovascular magnetic resonance imaging","volume":"27","author":"Chiribiri","year":"2025","journal-title":"J Cardiovasc Magn Reson"},{"key":"2026022618521947500_jeaf339-B11","doi-asserted-by":"crossref","first-page":"101085","DOI":"10.1016\/j.jocmr.2024.101085","article-title":"Comparison of dual bolus versus dual sequence techniques for determining myocardial blood flow and myocardial perfusion reserve by cardiac magnetic resonance stress perfusion: from the AQUA consortium","volume":"26","author":"Chong","year":"2024","journal-title":"J Cardiovasc Magn Reson"},{"key":"2026022618521947500_jeaf339-B12","doi-asserted-by":"crossref","first-page":"e240229","DOI":"10.1148\/rg.240229","article-title":"Invited commentary: quantitative stress perfusion: a new era and evolving technology","volume":"45","author":"Leung","year":"2025","journal-title":"Radiographics"},{"key":"2026022618521947500_jeaf339-B13","doi-asserted-by":"crossref","first-page":"101134","DOI":"10.1016\/j.jocmr.2024.101134","article-title":"Assessing microvascular dysfunction and predicting long-term prognosis in patients with cardiac amyloidosis by cardiovascular magnetic resonance quantitative stress perfusion","volume":"27","author":"Tang","year":"2025","journal-title":"J Cardiovasc Magn Reson"},{"issue":"8, Part 2","key":"2026022618521947500_jeaf339-B14","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1016\/j.jcmg.2018.10.032","article-title":"Microvascular dysfunction in dilated cardiomyopathy: a quantitative stress perfusion cardiovascular magnetic resonance study","volume":"12","author":"Gulati","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026022618521947500_jeaf339-B15","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1016\/j.jacc.2007.03.028","article-title":"Cardiovascular magnetic resonance perfusion imaging at 3-tesla for the detection of coronary artery disease: a comparison with 1.5-tesla","volume":"49","author":"Cheng","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2026022618521947500_jeaf339-B16","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.3348\/kjr.2018.19.6.1007","article-title":"Comparison of the diagnostic accuracies of 1.5T and 3T stress myocardial perfusion cardiovascular magnetic resonance for detecting significant coronary artery disease","volume":"19","author":"Min","year":"2018","journal-title":"Korean J Radiol"},{"key":"2026022618521947500_jeaf339-B17","first-page":"100388","article-title":"Differences in quantitative myocardial perfusion mapping by CMR at 1.5 T and 3 T","volume":"41","author":"Abraham","year":"2024","journal-title":"Am Heart J Plus"},{"key":"2026022618521947500_jeaf339-B18","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1093\/ehjci\/jeac231","article-title":"Sex- and age-specific normal values for automated quantitative pixel-wise myocardial perfusion cardiovascular magnetic resonance","volume":"24","author":"Brown","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026022618521947500_jeaf339-B19","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12968-018-0462-y","article-title":"Fully automated, inline quantification of myocardial blood flow with cardiovascular magnetic resonance: repeatability of measurements in healthy subjects","volume":"20","author":"Brown","year":"2018","journal-title":"J Cardiovasc Magn Reson"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeaf339\/65732332\/jeaf339.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/3\/544\/65732332\/jeaf339.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/3\/544\/65732332\/jeaf339.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T23:52:30Z","timestamp":1772149950000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/27\/3\/544\/8364374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,4]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,12,4]]},"published-print":{"date-parts":[[2026,2,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeaf339","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2025,12,4]]}}}