Current trends and challenges in the clinical use of cardiovascular magnetic resonance: a survey from the Italian Society of Cardiology

Abstract

Aims: Challenges related to the use of cardiovascular magnetic resonance (CMR) remain a key issue to secure its full clinical impact. This survey aimed to assess the awareness of CMR clinical utility and to collect data on its local usage levels, operational barriers, and report efficacy, with the goal of identifying key obstacles to its effective implementation across Italy.

Methods and results: The CMR Working Group of the Italian Society of Cardiology promoted an online survey targeting Italian physicians involved in direct care of patients with cardiovascular disease. The questionnaire was completed by 709 physicians, mostly working in public or university hospitals (75%); 27% were medical residents. Cardiomyopathies and myocarditis were identified as the most established clinical indications for CMR. 79% of respondents perceived underutilisation of CMR in their local settings, with waiting times exceeding 3 months in 42% of cases. Public hospitals were reported as the primary providers of CMR services (41%), with the majority of CMR reports signed exclusively by radiologists. Obstacles in obtaining clinically useful and effective CMR exams were frequent, with 69% of respondents often encountering issues. Need for an expert second opinion was reported by 27% of participants either often or always. Stress CMR was reported of limited access or unavailable by 79% of respondents.

Conclusion: CMR is highly regarded for its clinical utility but underutilized due to operational barriers, mainly long waiting times and lack of specific competence. Perceived inadequacy in report quality is common and contributes to a consistent rate of second-opinion requests.

Keywords: barriers; cardiovascular magnetic resonance; challenges; competency-based cardiac imaging; survey.

Graphical Abstract

Figure 1

Relevance of adequate cardiological training for CMR operators. Perceived level of involvement of operators with cardiology training (A); frequency of exam re-evaluation or repetition by cardiology-trained operators (B).

Figure 2

Perceived obstacles to appropriate clinical use of CMR in Italy. The frequency percentages shown in the x-axis of the chart represent cumulative proportions of responses, specifically combining both complete agreement and partial agreement. This means that the percentages reflect the total number of respondents who either fully agreed or partially agreed with each barrier being a significant factor affecting CMR access and utilisation. By aggregating these two levels of agreement, the chart provides a clearer picture of the overall perceived importance of each barrier.

Figure 3

Frequency of clinically inadequate reports and second opinion requests. The diagram on the left illustrates the frequency with which reports are considered clinically inadequate. The diagram on the right shows the frequency of second opinion requests. These visualisations highlight the need for improvement in report accuracy and clinical interpretation to reduce the necessity for second opinions and ensure more effective patient care.