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. 2023 Jul 3;25(1):38.
doi: 10.1186/s12968-023-00948-7.

Worldwide variation in cardiovascular magnetic resonance practice models

Lilia M Sierra-Galan  1 , Edgar E S Estrada-Lopez  2 , Victor A Ferrari  3 , Subha V Raman  4 , Vanessa M Ferreira  5 , Vimaj Raj  6 , Elizabeth Joseph  7 , Jeanette Schulz-Menger  8 , Carmen W S Chan  9 , Sylvia S M Chen  10 , Yuchen Cheng  11 , Juliano De Lara Fernandez  12 , Masahiro Terashima  13 , Timothy S E Albert  14
Affiliations

Worldwide variation in cardiovascular magnetic resonance practice models

Lilia M Sierra-Galan et al. J Cardiovasc Magn Reson. .

Abstract

Introduction: The use of cardiovascular magnetic resonance (CMR) for diagnosis and management of a broad range of cardiac and vascular conditions has quickly expanded worldwide. It is essential to understand how CMR is utilized in different regions around the world and the potential practice differences between high-volume and low-volume centers.

Methods: CMR practitioners and developers from around the world were electronically surveyed by the Society for Cardiovascular Magnetic Resonance (SCMR) twice, requesting data from 2017. Both surveys were carefully merged, and the data were curated professionally by a data expert using cross-references in key questions and the specific media access control IP address. According to the United Nations classification, responses were analyzed by region and country and interpreted in the context of practice volumes and demography.

Results: From 70 countries and regions, 1092 individual responses were included. CMR was performed more often in academic (695/1014, 69%) and hospital settings (522/606, 86%), with adult cardiologists being the primary referring providers (680/818, 83%). Evaluation of cardiomyopathy was the top indication in high-volume and low-volume centers (p = 0.06). High-volume centers were significantly more likely to list evaluation of ischemic heart disease (e.g., stress CMR) as a primary indicator compared to low-volume centers (p < 0.001), while viability assessment was more commonly listed as a primary referral reason in low-volume centers (p = 0.001). Both developed and developing countries noted cost and competing technologies as top barriers to CMR growth. Access to scanners was listed as the most common barrier in developed countries (30% of responders), while lack of training (22% of responders) was the most common barrier in developing countries.

Conclusion: This is the most extensive global assessment of CMR practice to date and provides insights from different regions worldwide. We identified CMR as heavily hospital-based, with referral volumes driven primarily by adult cardiology. Indications for CMR utilization varied by center volume. Efforts to improve the adoption and utilization of CMR should include growth beyond the traditional academic, hospital-based location and an emphasis on cardiomyopathy and viability assessment in community centers.

Keywords: CMR; Cardiovascular magnetic resonance; Practice models; Survey; World.

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Conflict of interest statement

LMSG has no competing interests, EESEL has no competing interests, SVR has institutional research support from Siemens, VMF receives support from the National Institute for Health Research (NIHR), Oxford Biomedical Research Centre (BRC), the British Heart Foundation (BHF), and the British Heart Foundation Centre of Research Excellence, Oxford, VR has no competing interests, EJ has no competing interests, VAF is member of the JCMR Senior Advisors Editorial Board, JSM has advisory relationships with Bayer, CWSC has no competing interests, SSMC has no competing interests, YC has no competing interests, JDLF has research agreements with Siemens AG, MT has no competing interests, TSEA has consulting and advisors relationships with Circle Cardiovascular Imaging, Inc.

Figures

Fig. 1
Fig. 1
Age distribution
Fig. 2
Fig. 2
CMR main indications segregated by high vs. low volume centers (> 1000 or < / = 1000 CMR studies per year. This figure shows CMR's main indications when the respondents’ centers are divided into two groups: low-volume centers, those with a volume of < / = 1000 CMR studies per year of any kind, and large-volume centers with > 1000 CMR studies per year of any kind. CMR cardiovascular magnetic resonance, NS non-significant, ASD atrial septal defect, VSD ventricular septal defect, PDA patent ductus arterioles, MRA magnetic resonance angiography
Fig. 3
Fig. 3
Ischemic and non-ischemic CMR main indications segregated by high vs. low volume centers (> or < / = 1000 CMR studies per year). This figure shows the distribution between ischemic and non-ischemic CMR studies and their main indications when the respondents’ centers are divided into two groups: low volume centers, those with a volume of < / = 1000 CMR studies per year of any kind, and large-volume centers with > 1000 CMR studies per year. The columns on the left labeled “IHD indications” include the following exam categories: myocardial ischemia evaluation with stress perfusion studies, the assessment of myocardial viability alone, and the evaluation of ischemic heart failure, which are also shown independently in the adjacent columns. The columns on the right (in green and red) compare all other non-ischemic heart disease-related indications. CMR cardiovascular magnetic resonance, IHD ischemic heart disease, HF heart failure
Fig. 4
Fig. 4
High vs. low volume centers analysis (< / = 1000 vs. > 1000 CMR studies per year)—main barriers to CMR implementation. This figure shows the CMR main barriers when the respondent centers are divided into two large groups: low-volume centers, those with a volume of < / = 1000 CMR studies per year of any kind, and those considered large-volume centers with a volume of > 1000 CMR studies per year of any kind. CMR cardiovascular magnetic resonance
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