Key result
Post-contrast SGE cine imaging in patients with cardiac implantable electronic devices yielded a four-fold higher likelihood of good image quality compared to conventional SSFP sequences.
Why the study?
Does a device-dependent CMR imaging strategy improve image quality in patients with cardiac implantable electronic devices compared to conventional sequences?
Observational (n=128)
Does a device-dependent CMR imaging strategy improve image quality in patients with cardiac implantable electronic devices compared to conventional sequences?
Effect estimate: 4-fold higher likelihood
A device-dependent CMR imaging strategy, particularly using post-contrast SGE cine imaging, significantly improves diagnostic image quality in patients with cardiac implantable electronic devices.
May improve cine quality in CIED patients; hypothesis-generating and should not yet change practice.
To prospectively determine evaluability of routine cardiovascular magnetic resonance (CMR) diagnostic modules in a referral population of implanted rhythm device all-comers, and to establish a device-dependent CMR imaging strategy to achieve optimal image quality. One hundred and twenty-eight patients with cardiac implantable electronic devices [insertable cardiac monitoring system, n = 14; implantable loop-recorder, n = 21; pacemaker, n = 31; implantable cardioverter-defibrillator (ICD), n = 50; and cardiac resynchronization therapy defibrillator (CRT-D), n = 12] underwent clinically indicated CMR at 1.5 T. CMR protocols were tailored to the clinical indication and consisted of cine, perfusion, T1-/T2-weighted, late-gadolinium enhancement (LGE), 3D angiographic, and post-contrast cine spoiled gradient echo (SGE) scans. Image quality was determined using a 4-grade visual score per myocardial segment. Segmental evaluability was strongly influenced by device type and location with the highest proportion of non-diagnostic images encountered in the presence of ICD/CRT-D systems. Cine steady-state free-precession (SSFP) imaging was found to be mostly non-diagnostic in ICD/CRT-D patients, but a significant improvement of image quality was demonstrated when using SGE sequences with a further incremental improvement post-contrast resulting in an overall four-fold higher likelihood of achieving good image quality. LGE scans were found to be non-diagnostic in about one-third of left-ventricular segments of ICD/CRT-D patients but were artefact-free in > 94% for all other device types. Device type and location constitute the main independent predictors of CMR image quality and thus, need to be considered during protocol adaptation. Most notably, post-contrast SGE cine imaging proved superior to conventionally used SSFP sequences. Thus, following the proposed device-dependent CMR imaging strategy, diagnostic image quality can be achieved in the majority of device patients.
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Hilbert et al. (2017) conducted an observational in Cardiac implantable electronic devices (n=128). Device-dependent CMR imaging strategy (post-contrast SGE cine) vs. Conventional SSFP sequences was evaluated on Image quality (4-grade visual score per myocardial segment) (4-fold higher likelihood). Post-contrast SGE cine imaging in patients with cardiac implantable electronic devices yielded a four-fold higher likelihood of good image quality compared to conventional SSFP sequences.
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