INCA (Peru) Study: Impact of Non‐Invasive Cardiac Magnetic Resonance Assessment in the Developing World

Abstract

BackgroundAdvanced cardiac imaging permits optimal targeting of cardiac treatment but needs to be faster, cheaper, and easier for global delivery. We aimed to pilot rapid cardiac magnetic resonance (CMR) with contrast in a developing nation, embedding it within clinical care along with training and mentoring.Methods and ResultsA cross‐sectional study of CMR delivery and clinical impact assessment performed 2016–2017 in an upper middle‐income country. An International partnership (clinicians in Peru and collaborators from the United Kingdom, United States, Brazil, and Colombia) developed and tested a 15‐minute CMR protocol in the United Kingdom, for cardiac volumes, function and scar, and delivered it with reporting combined with training, education and mentoring in 2 centers in the capital city, Lima, Peru, 100 patients referred by local doctors from 6 centers. Management changes related to the CMR were reviewed at 12 months. One‐hundred scans were conducted in 98 patients with no complications. Final diagnoses were cardiomyopathy (hypertrophic, 26%; dilated, 22%; ischemic, 15%) and 12 other pathologies including tumors, congenital heart disease, iron overload, amyloidosis, genetic syndromes, vasculitis, thrombi, and valve disease. Scan cost was $150 USD, and the average scan duration was 18±7 minutes. Findings impacted management in 56% of patients, including previously unsuspected diagnoses in 19% and therapeutic management changes in 37%.ConclusionsAdvanced cardiac diagnostics, here CMR with contrast, is possible using existing infrastructure in the developing world in 18 minutes for $150, resulting in important changes in patient care.

Clinical Validation of a 3-Dimensional Ultrafast Cardiac Magnetic Resonance Protocol Including Single Breath-Hold 3-Dimensional Sequences

“…The proposed ultrafast protocol can be applied to patients with heart diseases for which other rapid protocols, including more conventional techniques, have demonstrated clinical benefit (cardiomyopathy, chronic ischemic heart disease, and hypertensive heart disease [ 4 ]). As an improvement to this rapid protocol, the proposed protocol will simplify the overall examination workflow, potentially reducing the scan time to 3 breath-holds, including look-locker scan ( 12 ). In addition, the proposed 3D technique has been validated to assess RV anatomy and function, thus extending its application to other pathologies such as pulmonary hypertension, with similar reproducibility reported in previous works ( 22 ).…”

Potential for Rapid and Cost‐Effective Cardiac Magnetic Resonance in the Developing (and Developed) World

“…Endocardial definition is often high enough after contrast to perform accurate measurement of left ventricular mass and volumes. This is one of the ways the investigators in the present study in this issue of the Journal of the American Heart Association ( JAHA ) enabled a short CMR examination to be applied in Peru 6. Menacho and colleagues created a collaboration among investigators in 4 countries (United Kingdom, United States, Brazil, and Columbia).…”

Prognosis in patients with coronary heart disease and breath-holding limitations: a free-breathing cardiac magnetic resonance protocol at 3.0 T

“…For a randomly selected sample of 30 patients, the reproducibility of the IQ scores was evaluated by another senior observer. IQ scores were evaluated based on the 5-point Likert score ranging from 1 to 5 (5 = excellent image quality, 4 = normal image quality, 3 = presence of artifacts but sufficient image quality, 2 = severe artifacts in the area of the left ventricle, and 1 = completely nondiagnostic images) [ 11 , 12 , 15 ].…”