The Society for Cardiovascular Magnetic Resonance Registry at 150,000

Abstract

Background: Cardiovascular magnetic resonance (CMR) is increasingly utilized to evaluate expanding cardiovascular conditions. The Society for Cardiovascular Magnetic Resonance (SCMR) Registry is a central repository for real-world clinical data to support cardiovascular research, including those relating to outcomes, quality improvement, and machine learning. The SCMR Registry is built on a regulatory-compliant, cloud-based infrastructure that houses searchable content and Digital Imaging and Communications in Medicine images. The goal of this study is to summarize the status of the SCMR Registry at 150,000 exams.

Methods: The processes for data security, data submission, and research access are outlined. We interrogated the Registry and presented a summary of its contents.

Results: Data were compiled from 154,458 CMR scans across 20 United States sites, containing 299,622,066 total images (∼100 terabytes of storage). Across reported values, the human subjects had an average age of 58 years (range 1 month to >90 years old), were 44% (63,070/145,275) female, 72% (69,766/98,008) Caucasian, and had a mortality rate of 8% (9,962/132,979). The most common indication was cardiomyopathy (35,369/131,581, 27%), and most frequently used current procedural terminology code was 75561 (57,195/162,901, 35%). Macrocyclic gadolinium-based contrast agents represented 89% (83,089/93,884) of contrast utilization after 2015. Short-axis cines were performed in 99% (76,859/77,871) of tagged scans, short-axis late gadolinium enhancement (LGE) in 66% (51,591/77,871), and stress perfusion sequences in 30% (23,241/77,871). Mortality data demonstrated increased mortality in patients with left ventricular ejection fraction <35%, the presence of wall motion abnormalities, stress perfusion defects, and infarct LGE, compared to those without these markers. There were 456,678 patient-years of all-cause mortality follow-up, with a median follow-up time of 3.6 years.

Conclusion: The vision of the SCMR Registry is to promote evidence-based utilization of CMR through a collaborative effort by providing a web mechanism for centers to securely upload de-identified data and images for research, education, and quality control. The Registry quantifies changing practice over time and supports large-scale real-world multicenter observational studies of prognostic utility.

Keywords: Cardiovascular magnetic resonance; Infarction; Late gadolinium enhancement; Real-world evidence; Registry.

Central illustration: Composite diagram representation of the SCMR Registry, from automated data de-identification and aggregation (top left), cumulative growth over 5 years since creation (bottom left), geographic locations of participating sites (top right), and distribution of CMR indications (bottom right).

Fig. 1

Diagram process of the automated de-identification and cloud aggregation of clinical data into the SCMR Registry platform. SCMR Society for Cardiovascular Magnetic Resonance.

Fig. 2

Example of a de-identified report (A), respective DICOM images (B), and query interface (C) in the SCMR Registry. CO Cardiac output, EDD End-diastolic diameter, EDV End-diastolic volume, EF Ejection fraction, ESD End-systolic diameter, ESV End-systolic volume, DICOM Digital Imaging and Communications in Medicine, LAD left anterior descending artery, LCX left circumflex artery, LV left ventricle, RA Right atrium, RCA right coronary artery, RV Right ventricle, SCMR Society for Cardiovascular Magnetic Resonance.

Fig. 3

Distribution of CMR exams by age (A), most common CMR indications (B), and distribution of reported CPT codes after the 2008 update. Multiple CPT codes may be reported with each CMR exam (C). CMR cardiovascular magnetic resonance, CPT current procedural terminology, MRI magnetic resonance imaging, SCMR Society for Cardiovascular Magnetic Resonance.

Fig. 4

Utilization of linear or macrocyclic gadolinium-based contrast agents (GBCAs) by time (A) and 2015 GBCA designations by the American College of Radiology (B).

Fig. 5

Distribution of CMR exams based on scan date (A), cumulative CMR exams with each year (B), and years of follow-up after scan (C). CMR cardiovascular magnetic resonance.

Fig. 6

Mortality curves stratified by LVEF (A), regional wall motion (B), presence of inducible perfusion defects (C), and presence of infarct-pattern LGE (D). LVEF left ventricular ejection fraction, LGE late gadolinium enhancement.