Impact of Cardiac MRI in heart failure patients referred to a tertiary advanced heart failure unit: improvements in diagnosis and management

The clinical use of cardiac magnetic resonance (CMR) use in Australian heart failure patients has limited evidence. We examined how CMR, compared to routine echocardiography, affects diagnosis and management of patients with heart failure (HF). Single-center retrospective study of HF patients newly referred to the Advanced Heart Failure & Transplant unit at The Prince Charles Hospital, Brisbane. Between January 2010 to December 2014, all patients clinically referred for both CMR and echocardiography in the workup of HF were analyzed. Imaging results, electronic records and medical charts were reviewed for final diagnosis and changes in clinical management. 114 new heart failure referrals were included. Evaluation of HF of uncertain aetiology (70%) was the most common indication for CMR. In 20% of cases, CMR led to a completely new diagnosis or diagnostic confirmation of suspicions raised by echocardiography. Clinical decision-making was altered in 48%, with the greatest impact in decisions regarding revascularization. Overall, CMR had significant impact in 50% of patients. In a multivariable model, the only independent variable significantly associated with clinical impact was the presence/absence of late gadolinium enhancement (p CMR makes a substantial contribution to both diagnosis and management in HF patients over-and-above standard echocardiography. This study provides evidence of its clinical utility in the HF population in Australia and supports the role of CMR in the routine assessment of this cohort. This article is protected by copyright. All rights reserved.