I'm still playing around with ROHQ. It's not quite working, but there are lots of variables that you can alter (in the normal MC options even, not madvr). It's certainly fine on RO Standard and I had it working originally but in my messing around with ROHQ I think I've not put something back correctly and every so often, about once every 15 seconds, I get a slight "judder" even in RO Std.
I wasn't able to pin down which setting affects what. Being in Theater View as opposed to Standard View seems to affect it, together with the "automatically adjust frame rate" options. Setting the video card option to Automatic, Low, Medium or High didn't seem to affect anything at all.
I had it working at one point without any judder in ROHQ but there was a lip-sync issue. I couldn't get judder free ROHQ working with proper lip-sync - it was one or the other!
I'm convinced it should handle it though, it's just a question of finding the right configuration. To be perfectly frank though, I couldn't really detect any difference between ROSTD and ROHQ...