Key result
Cardiac magnetic resonance was used as a baseline diagnostic method in only 29.4% of adult patients with cardiomyopathies, highlighting a significant gap between guidelines and clinical practice.
Why the study?
Although CMR is the gold standard for diagnosing cardiomyopathies, it is time-consuming, expensive, and has limited availability across European regions, prompting evaluation of its real-world availability and applicability.
Observational (n=3,208)
Yes
CMR is underutilized in the baseline diagnosis of cardiomyopathies across Europe, revealing a significant gap between ESC guideline recommendations and real-world clinical practice.
CMR underuse at cardiomyopathy diagnosis may compromise phenotyping; leaves open the need for studies on barriers and outcome impact.
Background Cardiac magnetic resonance (CMR) constitutes a gold standard in the diagnosis of cardiomyopathies. Regardless of CMR advantages, the method is time-consuming, high-cost, with limited availability in some European regions. Purpose To assess the availability and applicability of CMR for establishing the diagnosis in different populations of patients with cardiomyopathies. Methods Overall, 3208 adult patients with cardiomyopathy (1119 / 34.9% females; median age at diagnosis: 49.0 years): 1260 with dilated (DCM), 1739 with hypertrophic (HCM), 66 with restrictive (RCM) and 143 with arrhythmogenic right ventricular cardiomyopathy (ARVC) enrolled in EURObservational Research Programme (EORP) – Cardiomyopathy/Myocarditis Long-Term Registry were analysed. Results CMR scan was performed as a baseline diagnostic method in 29.4% of patients; CMR was a single diagnostic method in 0.9% of patients and in 28.6% of patients CMR was used along with transthoracic echocardiography (TTE). In 67.6% of patients TTE was at the baseline the single diagnostic imaging method. Prevalence of CMR use in different cardiomyopathies was as follows: 20.6% in DCM, 33.8% in HCM, 36.4% in RCM and 51.1% in ARVC (p<0.001). Range of CMR applicability in different European regions was diverse from 0% up to 63.2%. The population with CMR use was younger, less symptomatic, with decreased prevalence of other cardiovascular risk factors and of associated cardiovascular diseases as compared to the population diagnosed without CMR scanning (p<0.001). Abnormal CMR results were present in 93.4% of patients with the highest percentage in RCM (95.8%) and HCM (94.9%) followed by DCM (91.5%) and the lowest abnormal CMR scan ratio in ARVC (87.7%) (p=0.030). The majority of CMR examinations comprised the assessment of late gadolinium enhancement (LGE, 93.3% at baseline). Presence of CMR LGE was observed in 69.3% of all patients: 59.1% in DCM, 73.8% in HCM, in 63.9% in ARVC and with the highest prevalence in RCM (83.3%) (p<0.001). Conclusion The study reveals real-life data on the low availability and applicability of CMR in adult patients with cardiomyopathies. The analysis shows the advantages of CMR imaging but also identifies the gaps between recommendations and clinical practice. Improvement regarding access, training and reimbursement is necessary to offer CMR to cardiomyopathy patients in accordance with the ESC guidelines. Funding Acknowledgement Type of funding source: None
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Mizia‐Stec et al. (2020) conducted an observational in Cardiomyopathies (n=3,208). Cardiac magnetic resonance (CMR) vs. Diagnosis without CMR scanning was evaluated on CMR scan performed as a baseline diagnostic method. Cardiac magnetic resonance was used as a baseline diagnostic method in only 29.4% of adult patients with cardiomyopathies, highlighting a significant gap between guidelines and clinical practice.
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