Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality

Hilbert, Sebastian; Jahnke, Cosima; Loebe, Susanne; Oebel, Sabrina; Weber, Alexander; Spampinato, Ricardo; Richter, Sergio; Doering, Michael; Bollmann, Andreas; Sommer, Philipp; Hindricks, Gerhard; Paetsch, Ingo

doi:10.1093/ehjci/jex243

Cited by 51 publications

(32 citation statements)

References 11 publications

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“…Consecutive patients referred for CMR imaging with an ICD between June 2015 and December 2018 formed the study population. The CMR examination rigorously followed a previously published, standardized protocol [5]. All patients underwent chest x-ray prior to the CMR examination and in the presence of abandoned, epicardial or fractured leads, CMR imaging was not performed (i.e.…”

Section: Patient Populationmentioning

confidence: 99%

“…However, more recent research addressed the pivotal issue of achieving adequately high diagnostic image quality of cardiovascular magnetic resonance (CMR) imaging in patients with implanted cardioverter defibrillator (ICD) and utilized well-established spoiled-gradient echo cine sequences following gadolinium-containing contrast agent application in combination with wideband late-gadolinium enhancement (LGE) imaging. Thus, the fundamental diagnostic CMR modules of basic ventricular functional assessment and myocardial tissue characterization have eventually become available for routine clinical usage in ICD patients either [5][6][7][8]. While previous investigations have largely focused on safety and image quality, the clinical impact and usefulness of CMR imaging in ICD patients have not been evaluated yet.…”

Section: Introductionmentioning

confidence: 99%

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Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms

Lindemann

Oebel

Paetsch

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Background: Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms. Methods: 212 consecutive ICD patients underwent 1.5 T CMR combining diagnostic imaging modules tailored to the individual clinical indication (ventricular function assessment, myocardial tissue characterization, adenosine stress-perfusion, 3D-contrast-enhanced angiography); four CMR examinations (4/212, 2%) were excluded due to non-diagnostic CMR image quality. The resultant change in diagnosis or clinical management was determined in the overall population and compared between ICD patients for primary (115/208, 55%) or secondary prevention (93/208, 45%). Referral indication consisted of documented ventricular tachycardia, inadequate device therapy or progressive heart failure symptoms. Results: Overall, CMR imaging data changed diagnosis in 40% (83/208) with a significant difference between primary versus secondary prevention ICD patients (37/115, 32% versus 46/93, 49%, respectively; p = 0.01). The information gain from CMR led to an overall change in treatment in 21% (43/208) with a similar distribution in primary versus secondary prevention ICD patients (25/115,22% versus 18/93,19%, p = 0.67). The effect on treatment change was highest in patients initially scheduled for ventricular tachycardia ablation procedure (18/141, 13%) with revision of the treatment plan to medical therapy or coronary revascularization. Conclusions: CMR imaging in ICD patients presenting with electrical instability or worsening heart failure symptoms provided diagnostic or management-changing information in a considerable proportion (40% and 21%, respectively).

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Section: Patient Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms

Lindemann

Oebel

Paetsch

et al. 2020

Journal of Cardiovascular Magnetic Resonance

Self Cite

View full text Add to dashboard Cite

show abstract

“…Strategies to reduce artifact generally yield interpretable results and so ensure clinical yield is high, which is particularly important for patients with ICDs [33]. These strategies include using spoiled gradient echo cines, shorter echo times, or wideband inversion recovery pulses for late gadolinium enhancement [34,35].…”

Section: Mri Artifactmentioning

confidence: 99%

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

et al. 2019

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More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this-newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.

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“…Scanning techniques are developing at a rapid rate; notably the recent study by Hilbert et al [44] has confirmed the utility of alternative protocols to help produce diagnostic grade images.…”

Section: Image Quality Optimisationmentioning

confidence: 99%

Cardiac magnetic resonance in patients with cardiac resynchronization therapy: is it time to scan with resynchronization on?

et al. 2019

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Cardiac resynchronisation therapy is recommended in international guidelines for patients with heart failure due to important left ventricular systolic dysfunction (or HEFREF) and ventricular conduction tissue disease. Cardiac magnetic resonance (CMR) represents the most powerful imaging tool for dynamic assessment of the volumes and function of cardiac chambers but is rarely utilised in patients with CRT due to limitations on the device, programming and scanning. In this review we explore the known utility of CMR in this cohort with discussion of the risks and potential benefits of scanning whilst CRT is active, including a practical strategy for conducting high quality scans safely. Our contention is that imaging in patients with CRT could be improved further by keeping resynchronisation therapy active with resultant benefits on research and also patient outcomes.

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Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality

Cited by 51 publications

References 11 publications

Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms

Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

Cardiac magnetic resonance in patients with cardiac resynchronization therapy: is it time to scan with resynchronization on?

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