Impact of cardiovascular magnetic resonance on management and clinical decision-making in heart failure patients

Abstract

BackgroundCardiovascular magnetic resonance (CMR) can provide important diagnostic and prognostic information in patients with heart failure. However, in the current health care environment, use of a new imaging modality like CMR requires evidence for direct additive impact on clinical management. We sought to evaluate the impact of CMR on clinical management and diagnosis in patients with heart failure.MethodsWe prospectively studied 150 consecutive patients with heart failure and an ejection fraction ≤50% referred for CMR. Definitions for “significant clinical impact” of CMR were pre-defined and collected directly from medical records and/or from patients. Categories of significant clinical impact included: new diagnosis, medication change, hospital admission/discharge, as well as performance or avoidance of invasive procedures (angiography, revascularization, device therapy or biopsy).ResultsOverall, CMR had a significant clinical impact in 65% of patients. This included an entirely new diagnosis in 30% of cases and a change in management in 52%. CMR results directly led to angiography in 9% and to the performance of percutaneous coronary intervention in 7%. In a multivariable model that included clinical and imaging parameters, presence of late gadolinium enhancement (LGE) was the only independent predictor of “significant clinical impact” (OR 6.72, 95% CI 2.56-17.60, p=0.0001).ConclusionsCMR made a significant additive clinical impact on management, decision-making and diagnosis in 65% of heart failure patients. This additive impact was seen despite universal use of prior echocardiography in this patient group. The presence of LGE was the best independent predictor of significant clinical impact following CMR.

Comparison of the prognostic value of regadenoson and adenosine myocardial perfusion imaging

“…In addition, changes in practice patterns and greater availability of other modalities likely impacted the referral population e.g., greater use of stress magnetic resonance imaging and fractional flow reserve. [19][20][21][22] However, there were no changes in data documentation, electronic medical record system, or methods of documenting clinical history. Moreover, the patients were all derived from a single academic medical center.…”

Potential for Rapid and Cost‐Effective Cardiac Magnetic Resonance in the Developing (and Developed) World

“…A new diagnosis was made in 19%, medication was changed or added in 23%, and other actions taken such as surgery, angiography, biopsy, hospital admission, etc in 13%. This impact on clinical decision making is in the same range as prior published results of large registries7 as well as pooled centers8 and single centers 9. The latter study by Abbasi et al9 was specifically targeted at patients with heart failure with reduced ejection fraction.…”

“…This impact on clinical decision making is in the same range as prior published results of large registries7 as well as pooled centers8 and single centers 9. The latter study by Abbasi et al9 was specifically targeted at patients with heart failure with reduced ejection fraction. This showed significant impact in 65% with a new diagnosis in 30% and change in management in 52%.…”

Cardiovascular PET/MR: We need evidence, not hype

“…However, given the costs of cardiac imaging, there is increasing pressure worldwide to show evidence for direct additive impact on clinical care. [3][4][5] Due to rising healthcare costs, appropriate use of cardiovascular imaging is under increasing scrutiny and emphasized by professional societies, third-party payers, and accreditation agencies. [3][4][5] In this climate, the responsibility for showing additive benefit lies on the shoulders of those advocating for new, more expensive technologies.…”

“…[3][4][5] Due to rising healthcare costs, appropriate use of cardiovascular imaging is under increasing scrutiny and emphasized by professional societies, third-party payers, and accreditation agencies. [3][4][5] In this climate, the responsibility for showing additive benefit lies on the shoulders of those advocating for new, more expensive technologies. Moreover, given the potential harmful effects of exposure to ionizing radiation, the addition of PET to a CMR-only protocol needs to have compelling evidence-based benefits.…”