Impact of cardiac magnetic resonance imaging on cardiac device and surgical therapy: a prospective study

Abstract

Cardiac magnetic resonance (CMR) imaging may allow more appropriate selection of patients for cardiac device implantation and/or cardiac surgery. In this prospective observational study we evaluated the impact of CMR imaging on cardiac device and surgical therapy. All CMR examinations performed in a single centre over a 2 year period were prospectively recorded in a dedicated database under 4 clinical pathways [cardiomyopathy, viability, tumour/mass and arrythmogenic right ventricular cardiomyopathy (ARVC)]. Baseline data entered included planned cardiac device implantation and/or cardiac surgical intervention. Patients were contacted 6 months following CMR to evaluate the impact of CMR on planned therapy. Cost savings due to CMR were calculated as the number of surgical or device procedures averted following CMR scanning multiplied by their respective cost weights. Of 732 CMR examinations performed, the clinical pathway was cardiomyopathy in 488 (67 %), ARVC in 118 (16 %), viability in 92 (12 %) and tumour/mass in 34 (5 %). Six month follow-up was available in 666/732 patients. Following CMR, 56/150 (37 %) of patients with an initial plan for device implantation or cardiac surgery, did not undergo the planned intervention (P < 0.001, one-sample exact binomial test). Of 516 patients without an initial device or surgical plan, 33 (6 %) CMR resulted in device implantation or cardiac surgery (P < 0.001, Chi squared). Overall, the estimated saving due to CMR-guided management changes was AUD$737,270. CMR has a significant impact on patient management and offers potential cost savings with respect to selection of device and surgical therapy for cardiac disease.

Impact of cardiac magnetic resonance imaging on heart failure patients referred to a tertiary advanced heart failure unit: improvements in diagnosis and management

“…Based on Australian healthcare costs, Taylor et al . demonstrated an estimated cost saving of AUD $737 270 within a 2‐year period based on CMR guidance of device implantation and cardiac surgery ( n = 732) . While we did not calculate the economic implications (cost–utility analysis), which would be of relevance to policy and healthcare delivery, drawing from prior favourable trends, we postulate that negative findings on routine CMR could similarly diminish the need for downstream investigations or invasive interventions and their associated costs in the Australian healthcare context.…”

“…Several other single‐centre studies showed similar favourable findings. An Australian study established its utility in the planning of cardiac surgery and device therapy implantation . Narrowing the target population exclusively to HF patients, Arumugam et al .…”

Cardiac Imaging in Heart Failure with Comorbidities

“…CMR is the gold standard for imaging myocardial fibrosis. With accurate measures of relaxation properties of tissues, changes in content of various components can be estimated and monitored over time to determine fluctuations between inflammation or fibrosis from many groups [ 133 - 147 ]. Myocardial fibrosis is a significant cause and consequence for HF.…”

“…This highlights again that across the spectrum of the comorbid disease serial CMR can predict and monitor progression with therapies as early as ACC stage 1, or recommend those who require more aggressive treatment [ 168 , 169 ]. There have also been benefits reported for predicting clinical response to resynchronization therapies [ 141 , 142 , 145 - 147 ] and electrophysiological procedures [ 140 , 146 ].…”