Key result
Routine CMR alters clinical management in ~66% of patients with excellent safety and image quality.
Why the study?
CMR is increasingly used across a broad range of clinical applications, but its routine indications, image quality, safety, and impact on patient management needed evaluation.
What are the indications, safety, image quality, and clinical impact of routine CMR in clinical practice?
Observational (n=11,040)
Yes
What are the indications, safety, image quality, and clinical impact of routine CMR in clinical practice?
Routine CMR is a safe procedure that provides high diagnostic image quality and significantly impacts patient management, frequently satisfying all imaging needs without requiring further tests.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Consequently, CMR stress testing for risk stratification in suspected coronary artery disease may have the potential to significantly bring down the number of diagnostic coronary angiographies that do not result in intervention or surgery in the future. In addition, nearly 700 noninvasive procedures involving the use of ionizing radiation, such as SPECT imaging, could also be avoided on the basis of the CMR results.”
May support CMR integration into workflows; leaves open whether randomized trials confirm outcome benefits.
OBJECTIVES: During its German pilot phase, the EuroCMR (European Cardiovascular Magnetic Resonance) registry sought to evaluate indications, image quality, safety, and impact on patient management of routine CMR. BACKGROUND: CMR has a broad range of applications and is increasingly used in clinical practice. METHODS: This was a multicenter registry with consecutive enrollment of patients in 20 German centers. RESULTS: A total of 11,040 consecutive patients were enrolled. Eighty-eight percent of patients received gadolinium-based contrast agents. Twenty-one percent underwent adenosine perfusion, and 11% high-dose dobutamine-stress CMR. The most important indications were workup of myocarditis/cardiomyopathies (32%), risk stratification in suspected coronary artery disease/ischemia (31%), as well as assessment of viability (15%). Image quality was good in 90.1%, moderate in 8.1%, and inadequate in 1.8% of cases. Severe complications occurred in 0.05%, and were all associated with stress testing. No patient died during or due to CMR. In nearly two-thirds of patients, CMR findings impacted patient management. Importantly, in 16% of cases the final diagnosis based on CMR was different from the diagnosis before CMR, leading to a complete change in management. In more than 86% of cases, CMR was capable of satisfying all imaging needs so that no further imaging was required. CONCLUSIONS: CMR is frequently performed in clinical practice in many participating centers. The most important indications are workup of myocarditis/cardiomyopathies, risk stratification in suspected coronary artery disease/ischemia, and assessment of viability. CMR imaging as used in the centers of the pilot registry is a safe procedure, has diagnostic image quality in 98% of cases, and its results have strong impact on patient management.
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Bruder et al. (2009) conducted an observational in Patients undergoing routine cardiovascular magnetic resonance (n=11,040). Routine cardiovascular magnetic resonance (CMR) was evaluated on Indications, image quality, safety, and impact on patient management. Routine cardiovascular magnetic resonance imaging was safe (0.05% severe complications), had diagnostic image quality in 98% of cases, and impacted management in nearly two-thirds of patients.
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