7 Clinical impact of cardiovascular magnetic resonance on the management of acutely hospitalised patients

Background Cardiac Magnetic Resonance (CMR) is invaluable for assessing ischaemic and non-ischaemic cardiomyopathies. However, evidence regarding the incremental impact of CMR in acutely hospitalised patients is scarce. We evaluated the impact of CMR on diagnosis and clinical decision-making in this cohort. Methods We evaluated 2481 consecutive scans (Jan 2014-Dec 2014) at a large tertiary cardiothoracic centre, identifying 283 patients referred for inpatient scans. Protocol included short axis-long axis cines, T2-weighted oedema sequences, early and late gadolinium enhancement (LGE) images. Definitions for “significant clinical impact” of CMR included change in pre-CMR diagnosis, influence on hospitalisation period, change in medication and on decision making for invasive medical procedures (CABG, angiography, ICD implantation). Results Of the 283 patients, 8 were excluded due to poor image quality, leaving 275 patients (66% male, mean age 59yrs), mean ejection fraction of 46% ± 19. Patients underwent CMR for further assessessment of ischaemic heart disease, cardiomyopathy or congenital heart disease. CMR demonstrated significant clinical impact on 68% of patients. This included a completely new diagnosis in 27% of patients, change in management in 31% and 10% of patients that had both a new diagnosis and change in management. CMR results promoted invasive procedures on 27%, avoided invasive procedures on 16%; and influenced on hospital discharge on 15% of the patients (Figure 1). 84% of the patients had echocardiography prior to CMR. CMR confirmed echo diagnosis in 11%, complemented echo findings with significant new information in 41% and changed the echo diagnosis in 30% of the cases. In a multivariable model that included clinical/imaging parameters, age and presence of LGE were the only independent predictors of “significant clinical impact” (LGE p-value .007, OR 2.782, CI 1.328–5.828) (Table 1). Conclusions CMR had significant impact in patient’s diagnosis and management in 68% of acutely hospitalised patients. Presence of LGE was the only independent predictor of significant clinical impact following CMR.