Heart failure

Australian evidence backs cardiac MRI in heart failure

Cardiac MRI should be used in the routine assessment of heart failure say cardiologists who found the imaging modality had benefits over and above guideline recommended echocardiography.

Cardiologist and imaging specialist Dr Christian Hamilton-Craig from The Prince Charles Hospital, Brisbane, and colleagues said identifying the cause of heart failure was critical in order to guide management. However a correct diagnosis was sometimes challenging, with evidence showing that one third of patients diagnosed with non-ischaemic cardiomyopathy had atherosclerotic coronary artery disease at post-mortem.

They noted that current guidelines by the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand recommended transthoracic echocardiography (TTE) as the primary imaging modality in heart failure evaluation.

Although TTE was affordable, quick, repeatable and widely available, echocardiographic measurements could be undermined by geometrical assumptions and limited by poor acoustic windows.

“Cardiac magnetic resonance imaging (CMR) has emerged as a noninvasive imaging modality providing precise measurements without geometrical assumption and ionising radiation exposure,” they wrote in the study published in the Internal Medicine Journal.

In their study of 114 patients referred to their advanced heart failure unit, the research team found that cardiac MRI had a clinical impact in half of the patients, with 20% of patients receiving a new diagnosis and 48% a change in therapeutic and management decisions.

According to the authors the greatest impact was seen with decisions concerning revascularisation, determined largely by the presence or absence of myocardial viability.

“Our study demonstrates a substantial contribution of CMR to both diagnosis and management over and-above routine echocardiography imaging in a cohort of heart failure patients referred to a quaternary heart failure centre,” the research team concluded.

“CMR has value in addition to echocardiography and may operate as a gatekeeper to subsequent invasive, costly interventions,” they added.

They said  more cost-utility and prognostic studies were now needed to provide evidence for the application of CMR funding in the Australian healthcare setting.

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