Noninvasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in low-middle income countries

Abstract

Introduction: Cardiac Magnetic Resonance (CMR) is a crucial diagnostic imaging test that redefines diagnosis and enables targeted therapies, but the access to CMR is limited in low-middle Income Countries (LMICs) even though cardiovascular disease is an emergent primary cause of mortality in LMICs. New abbreviated CMR protocols can be less expensive, faster, whilst maintaining accuracy, potentially leading to a higher utilization in LMICs.Areas covered: This article will review cardiovascular disease in LMICs and the current role of CMR in cardiac diagnosis and enable targeted therapy, discussing the main obstacles to prevent the adoption of CMR in LMICs. We will then review the potential utility of abbreviated, cost-effective CMR protocols to improve cardiac diagnosis and care, the clinical indications of the exam, current evidence and future directions.Expert opinion: Rapid CMR protocols, provided that they are utilized in potentially high yield cases, could reduce cost and increase effectiveness. The adoption of these protocols, their integration into care pathways, and prioritizing key treatable diagnoses can potentially improve patient care. Several LMIC countries are now pioneering these approaches and the application of rapid CMR protocols appears to have a bright future if delivered effectively.

Bringing MRI to low‐ and middle‐income countries: Directions, challenges and potential solutions

“…This may be beneficial to both LMICs and HICs, allowing greater throughput. 151 To improve efficiency, rapid MRI protocols could be shared via open access and internationally to increase access. This would help compensate for the lack of expertise in some countries through the development of a sharing platform that is easily accessible.…”

“…Diagnostic‐quality images were produced in a shorter scan time. This may be beneficial to both LMICs and HICs, allowing greater throughput 151 . To improve efficiency, rapid MRI protocols could be shared via open access and internationally to increase access.…”

Let there be light! The meteoric rise of cardiac imaging

“…The latter has transformed the monitoring and care of patients with haemochromatosis and those receiving regular blood transfusions and leading to major improvements in patient cardiovascular outcomes 68. Recent additional advances include 4D flow,69 myocardial tractography, manganese CMR, rapid CMR protocols,70–72 studies demonstrating the safety of CMR imaging in patients with cardiac devices70 and CMR imaging in patients with COVID-1973 all led by UK investigators and set to further develop the role of CMR in clinical practice.…”