NEW YORK (Reuters Health) - Non-invasive cardiac magnetic resonance (CMR) with contrast can be performed in 18 minutes for $150 in a developing-world setting using existing infrastructure, according to a new study.
And CMR findings from the test changed clinical management for most patients, Dr. James C. Moon of St. Bartholomew's Hospital in London, UK, and colleagues report in the September 4 issue of the Journal of the American Heart Association.
Low- and middle-income countries have the highest rate of cardiovascular disease (CVD) and death, although their burden of traditional heart disease risk factors is lower than in richer countries, the authors note. In the developed world, CMR is used to boost diagnostic accuracy and target treatment, but the test is currently too time-consuming and costly for widespread use in resource-limited settings.
Dr. Moon and researchers from the U.K., U.S., Brazil and Colombia partnered with clinicians in Peru to develop and test a 15-minute CMR protocol in the UK, abbreviating the test by only including left ventricular function (VF) and late gadolinium enhancement (LGE) imaging for scar, the "core incremental diagnostic utility" of CMR over echocardiography.
They piloted the test in two centers in Lima, Peru, in 100 patients referred by local doctors. A total of 100 scans were performed in 98 patients, including 26% with hypertrophic cardiomyopathy, 22% with non-ischemic dilated cardiomyopathy, 15% with ischemic cardiomyopathy including viability, and 12 other indications.
At 12 months, CMR findings changed clinical management in 56% of the patients, including 19% who received a new diagnosis and 37% who had therapeutic management changes.
"We take for granted some of our sophisticated technology, but this can be repurposed to help the global community, most of which lives in countries with lower income," Dr. Moon told Reuters Health by phone. "We got a much higher yield and value for the images than we would get in the UK, for example."
"We want to see whether these countries, who have incredibly talented doctors, can train the next generation," he added. "We want to get this into all upper-middle-income countries. It's the way forward."
Dr. Christopher M. Kramer of the University of Virginia Health System in Charlottesville, who wrote an accompanying editorial, told Reuters Health by phone, "This is a nice feasibility study."
"What they did in this study is left some things out that might otherwise be done, and they really focused on the critical information in these patients, and they could get all that in 20 minutes," he said, noting that a standard MRI exam can take 45 minutes to an hour.
SOURCE: https://bit.ly/2Qca20q and https://bit.ly/2wL7RbN
J Am Heart Assoc 2018.