What question did this study set out to answer?

To evaluate the overall diagnostic yield, safety, and extent of metal artifacts during cardiovascular magnetic resonance in patients with cardiac implantable electronic devices.

October 22, 2023Journal of Clinical MedicineOpen Access

Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study

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Why the study?

Most recent CIEDs can safely undergo CMR under certain conditions, but metal artifacts may degrade image quality.

Does cardiovascular magnetic resonance (CMR) provide good diagnostic yield and safety in patients with MR-conditional cardiac implantable electronic devices (CIEDs)?

Key Points

To evaluate the overall diagnostic yield, safety, and extent of metal artifacts during cardiovascular magnetic resonance in patients with cardiac implantable electronic devices.
Multicenter study conducted across 10 centers (2012–2020) evaluating patients with pacemakers (n = 122), defibrillators (n = 149), or loop recorders (n = 38), excluding MR-unsafe implants.
Device function parameters were evaluated before and after cardiovascular magnetic resonance, and metal artifacts were assessed across myocardial segments using a 5-point artifact scoring system.
Full scan completion occurred in 83% of cases (n = 255), with good image quality obtained in 68% (n = 201), acceptable quality in 13% (n = 40), poor quality in 8% (n = 25), and non-diagnostic scans in 11% (n = 34).
No adverse clinical events or device malfunctions occurred, with only nonsignificant changes observed in post-scan device parameters.
Artifact scores were highest for steady-state free precession (median 0.32 [IQR 0.07–0.91]) compared to gradient-recalled echo (0.18 [0.02–0.59]) and late gadolinium enhancement (0.14 [0.02–0.55]), with defibrillators generating more artifacts (median 0.87) than pacemakers (0.11) or loop recorders (0.11).

Structured PICO

Does cardiovascular magnetic resonance (CMR) provide good diagnostic yield and safety in patients with MR-conditional cardiac implantable electronic devices (CIEDs)?

Population

309 patients with MR-conditional cardiac implantable electronic devices (pacemaker n=122, defibrillator n=149, or loop recorder n=38) referred for cardiovascular magnetic resonance (CMR)

Intervention

Cardiovascular magnetic resonance (CMR) scan

Outcome

Overall diagnostic yield of CMR and the extent of metal artifacts based on a 5-point artifact scoresurrogate

CMR is safe and provides overall good image quality in patients with MR-conditional CIEDs, though ICDs induce more artifacts than pacemakers or loop recorders.

Implication

I have the paper; next I’ll pull the full results and conclusions so the implication tracks the primary endpoint.May support indicated CMR in MR-conditional CIEDs; confirms multicenter safety and extends prior single-center diagnostic-yield data.

Abstract

BACKGROUND: Most recent cardiac implantable electronic devices (CIEDs) can safely undergo a cardiovascular magnetic resonance (CMR) scan under certain conditions, but metal artifacts may degrade image quality. The aim of this study was to assess the overall diagnostic yield of CMR and the extent of metal artifacts in a multicenter, multivendor study on CIED patients referred for CMR. METHODS: = 122), defibrillator (n = 149), or loop recorder (n = 38); CMR scans were performed in 10 centers from 2012 to 2020; MR-unsafe implants were excluded. Clinical and device parameters were recorded before and after the CMR scan. A visual analysis of metal artifacts was performed for each sequence on a segmental basis, based on a 5-point artifact score. RESULTS: The vast majority of CMR scans (n = 255, 83%) were completely performed, while only 32 (10%) were interrupted soon after the first sequences and 22 (7%) were only partly acquired; CMR quality was non-diagnostic in 34 (11%) scans, poor (<1/3 sequences were diagnostic) in 25 (8%), or acceptable (1/3 to 2/3 sequences were diagnostic) in 40 (13%), while most scans (n = 201, 68%) were of overall good quality. No adverse event or device malfunctioning occurred, and only nonsignificant changes in device parameters were recorded. The most affected sequences were SSFP (median score 0.32 [interquartile range 0.07-0.91]), followed by GRE (0.18 [0.02-0.59]) and LGE (0.14 [0.02-0.55]). ICDs induced more artifacts (median score in SSFP images 0.87 [0.50-1.46]) than PMs (0.11 [0.03-0.28]) or ILRs (0.11 [0.00-0.56]). Moreover, most artifacts were located in the anterior, anteroseptal, anterolateral, and apical segments of the LV and in the outflow tract of the RV. CONCLUSIONS: CMR is a versatile imaging technique, with a high safety profile and overall good image quality even in patients with MR-conditional CIEDs. Several strategies are now available to optimize image quality, substantially enhancing overall diagnostic yield.