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Observational Study
. 2013 Oct 1;15(1):89.
doi: 10.1186/1532-429X-15-89.

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

Siddique A Abbasi  1 , Andrew Ertel, Ravi V Shah, Vineet Dandekar, Jaehoon Chung, Geetha Bhat, Ankit A Desai, Raymond Y Kwong, Afshin Farzaneh-Far
Affiliations
Observational Study

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

Siddique A Abbasi et al. J Cardiovasc Magn Reson. .

Erratum in

  • J Cardiovasc Magn Reson. 2014;16:20

Abstract

Background: Cardiovascular 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.

Methods: We 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).

Results: Overall, 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).

Conclusions: CMR 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.

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Figures

Figure 1
Figure 1
Definition of Significant Clinical Impact. PCI=percutaneous coronary intervention; CABG=coronary artery bypass grafting; ICD=implantable cardioverter-defibrillator.
Figure 2
Figure 2
Example of a New Diagnosis. A 32 year-old woman with sickle cell anemia was referred for evaluation of iron overload by T2* imaging, which was normal. However, nearly transmural hyperenhancement (white arrows) was seen in the apical inferior wall on late enhancement imaging, indicative of previously unrecognized myocardial infarction.
Figure 3
Figure 3
Example of a Change in Management. A 65 year-old man was referred for assessment of ventricular function and viability testing. CMR unexpectedly revealed a large apical thrombus, for which the patient was admitted to hospital for initiation of systemic anticoagulation.
Figure 4
Figure 4
Change in diagnosis after performance of CMR. Weighted lines represent number of patients (also numerically represented within the circle).
Figure 5
Figure 5
Significant Clinical Impact of CMR. On the basis of CMR findings, 52% of patients had a change in management and 30% of patients had a new diagnosis. In 17% of patients CMR resulted in both a change in management and a new diagnosis. In total, CMR had a significant clinical impact on 65% of patients.
See this image and copyright information in PMC

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