AlJaroudi Wael, Isma'eel Hussain, El Merhi Fadi, Assad Tony, Hourani Mukbil
1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Cardiovasc Diagn Ther. 2015 Apr;5(2):88-97. doi: 10.3978/j.issn.2223-3652.2014.11.01.
Cardiac magnetic resonance imaging (CMRI) is a novel non-invasive modality with many potential indications, and was recently introduced in Lebanon. We sought to assess the appropriateness and diagnostic yield of CMR studies performed at a tertiary referral center from the Middle East since the inception of the program.
All patients who underwent CMR studies between January 1(st) 2013 and June 18(th) 2014 were enrolled in this study. CMR reports were retrospectively reviewed. The study indication, clinical history, and findings were extracted and analyzed. The appropriateness of the study was judged according to the 2010 updated Asian Society of Cardiac Imaging guidelines.
There were a total of 142 patients [mean age 42.1 (SD: 18) years, 24.6% females] that underwent CMR study. Two-thirds of studies were performed on an outpatient basis, and outside referrals constituted 16.2% of the entire cohort. The cardiologists referred 122 cases (86%) with main contribution from electrophysiology and imaging specialists. Of the 142 cases, 12 (8.4%) were not indicated and added little value. Of the remaining 130 appropriate studies (appropriateness level A8-A9), one-third had an incorrect diagnosis prior to CMR, and 8% had relevant findings that were missed on other studies but captured by CMR. Furthermore, CMR confirmed the diagnosis in 28% of the cases, provided relevant information on scar burden, shunt quantification, and ruled out infiltrative disease in the remaining patients. Also, CMR demonstrated the presence of scar in 45 of patients, among whom 20 (44%) had significant scar volume quantification (>5% of left ventricular myocardium). Finally, 9% of patients had a relevant extra-cardiac finding that needed further investigation.
Despite the recent launch of the CMR program at our institution, the majority of studies were appropriately indicated, provided relevant data and were clinically useful. Inappropriate or uncertain studies did not provide relevant data, and should be further minimized to avoid unnecessary costs and downstream testing. Large prospective CMR database with clinical follow-up is needed to provide more insight about cardiovascular disease and outcomes in our population.
心脏磁共振成像（CMRI）是一种具有多种潜在适应证的新型非侵入性检查方法，最近在黎巴嫩开始应用。我们试图评估自该项目启动以来，在中东一家三级转诊中心进行的CMR检查的适宜性和诊断率。
纳入2013年1月1日至2014年6月18日期间接受CMR检查的所有患者。对CMR报告进行回顾性审查。提取并分析研究适应证、临床病史和检查结果。根据2010年更新的亚洲心脏影像学会指南判断检查的适宜性。
共有142例患者[平均年龄42.1（标准差：18）岁，女性占24.6%]接受了CMR检查。三分之二的检查在门诊进行，外部转诊患者占整个队列的16.2%。心脏病专家转诊了122例（86%），主要由电生理和影像专家促成。在142例病例中，12例（8.4%）检查无适应证且价值不大。在其余130例适宜检查（适宜性水平A8 - A9）中，三分之一在CMR检查前诊断错误，8%有其他检查遗漏但CMR检查发现的相关结果。此外，CMR在28%的病例中证实了诊断，为其余患者提供了关于瘢痕负荷、分流定量的相关信息，并排除了浸润性疾病。而且，CMR在45%的患者中显示存在瘢痕，其中20例（44%）有显著的瘢痕体积定量（>左心室心肌的5%）。最后，9%的患者有需要进一步检查的相关心脏外发现。
尽管我们机构最近启动了CMR项目，但大多数检查适应证适宜，提供了相关数据且具有临床实用性。不适当或不确定的检查未提供相关数据，应进一步减少以避免不必要的费用和后续检查。需要建立大型前瞻性CMR数据库并进行临床随访，以更深入了解我们人群中的心血管疾病和预后情况。
