BackgroundAdvanced cardiac imaging permits optimal targeting of cardiac treatment but needs to be faster, cheaper, and easier for global delivery. We aimed to pilot rapid cardiac magnetic resonance (CMR) with contrast in a developing nation, embedding it within clinical care along with training and mentoring.Methods and ResultsA cross‐sectional study of CMR delivery and clinical impact assessment performed 2016–2017 in an upper middle‐income country. An International partnership (clinicians in Peru and collaborators from the United Kingdom, United States, Brazil, and Colombia) developed and tested a 15‐minute CMR protocol in the United Kingdom, for cardiac volumes, function and scar, and delivered it with reporting combined with training, education and mentoring in 2 centers in the capital city, Lima, Peru, 100 patients referred by local doctors from 6 centers. Management changes related to the CMR were reviewed at 12 months. One‐hundred scans were conducted in 98 patients with no complications. Final diagnoses were cardiomyopathy (hypertrophic, 26%; dilated, 22%; ischemic, 15%) and 12 other pathologies including tumors, congenital heart disease, iron overload, amyloidosis, genetic syndromes, vasculitis, thrombi, and valve disease. Scan cost was $150 USD, and the average scan duration was 18±7 minutes. Findings impacted management in 56% of patients, including previously unsuspected diagnoses in 19% and therapeutic management changes in 37%.ConclusionsAdvanced cardiac diagnostics, here CMR with contrast, is possible using existing infrastructure in the developing world in 18 minutes for $150, resulting in important changes in patient care.

Aims To evaluate the impact of a simplified, rapid cardiovascular magnetic resonance (CMR) protocol embedded in care and supported by a partner education programme on the management of cardiomyopathy (CMP) in low- and middle-income countries (LMICs). Methods and results Rapid CMR focused particularly on CMP was implemented in 11 centres, 7 cities, 5 countries, and 3 continents linked to training courses for local professionals. Patients were followed up for 24 months to assess impact. The rate of subsequent adoption was tracked. Five CMR conferences were delivered (920 attendees—potential referrers, radiographers, reporting cardiologists, or radiologists) and five new centres starting CMR. Six hundred and one patients were scanned. Cardiovascular magnetic resonance indications were 24% non-contrast T2* scans [myocardial iron overload (MIO)] and 72% suspected/known cardiomyopathies (including ischaemic and viability). Ninety-eighty per cent of studies were of diagnostic quality. The average scan time was 22 ± 6 min (contrast) and 12 ± 4 min (non-contrast), a potential cost/throughput reduction of between 30 and 60%. Cardiovascular magnetic resonance findings impacted management in 62%, including a new diagnosis in 22% and MIO detected in 30% of non-contrast scans. Nine centres continued using rapid CMR 2 years later (typically 1–2 days per week, 30 min slots). Conclusions Rapid CMR of diagnostic quality can be delivered using available technology in LMICs. When embedded in care and a training programme, costs are lower, care is improved, and services can be sustained over time. Key question Key finding Take-home message

La enfermedad cardiovascular es la causa principal de mortalidad y morbilidad en el mundo y se estima que su prevalencia irá en aumento debido al incremento en la prevalencia de los factores de riesgo según la Organización Mundial de la Salud (OMS). En el Perú, la enfermedad cardiovascular es la segunda causa de muerte, por ello la detección de isquemia es una parte importante de la estrategia diagnóstica en pacientes que tienen sospecha de enfermedad coronaria, puesto que es un fuerte predictor de eventos adversos como infarto de miocardio y muerte de origen cardiovascular.La resonancia magnética cardíaca con estrés farmacológico para evaluar isquemia es una herramienta diagnóstica no invasiva que ofrece muchas ventajas sobre otras técnicas diagnósticas ya que tiene una alta resolución espacial y ausencia de exposición a la radiación. Su precisión diagnóstica para detectar enfermedad coronaria es alta, así como su valor pronóstico en los pacientes con sospecha de esta enfermedad.En esta revisión se describirá cómo se realiza el estudio de resonancia magnética cardiaca con estrés farmacológico para detección de isquemia y también se discutirá el valor pronóstico y diagnóstico en pacientes con sospecha de enfermedad coronaria.