seanami
Maybe you could also try setting "processing threads" to 24 or 26.
The reason I am suggesting that is because I have the exact same CPU model as you (and it seems the same monitor as well, Asus ROG Swift, no?) and 26 threads allows me to completely "max out" the normal profile settings without dropping frames, while lowering the number of threads results in reduced CPU utilization and the accompanying frame drops that go with it (if the quality settings are not lowered).
I do get the occasional script restart due to "memory leak detection" and sometimes MPC-HC crashes, but the increased interpolation accuracy is well worth it to me.
As always though, if you are happy with the current performance at 19 threads then it might not be the best idea to fix what is not broken...
Ps. I saw your MadVR settings screenshot and have you ever tried increasing your "render queue" so that it is more than your "present queue"? It might also help with stability and smoothness.