First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Center, 47 Ziolowa St., 40-635 Katowice, Poland.
APHP, Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, ICAN, Hôpital Pitié-Salpêtrière, Paris, France and Sorbonne Université, Inserm UMR1166, Paris, France.
Eur Heart J Cardiovasc Imaging. 2021 Jun 22;22(7):781-789. doi: 10.1093/ehjci/jeaa329.
Cardiac magnetic resonance (CMR) is recommended in the diagnosis of cardiomyopathies, but it is time-consuming, expensive, and limited in availability in some European regions. The aim of this study was to determine the use of CMR in cardiomyopathy patients enrolled into the European Society of Cardiology (ESC) cardiomyopathy registry [part of the EURObservational Research Programme (EORP)].
Three thousand, two hundred, and eight consecutive adult patients (34.6% female; median age: 53.0 ± 15 years) with cardiomyopathy were studied: 1260 with dilated (DCM), 1739 with hypertrophic (HCM), 66 with restrictive (RCM), and 143 with arrhythmogenic right ventricular cardiomyopathy (ARVC). CMR scans were performed at baseline in only 29.4% of patients. CMR utilization was variable according to cardiomyopathy subtypes: from 51.1% in ARVC to 36.4% in RCM, 33.8% in HCM, and 20.6% in DCM (P < 0.001). CMR use in tertiary referral centres located in different European countries varied from 1% to 63.2%. Patients undergoing CMR were younger, less symptomatic, less frequently had implantable cardioverter-defibrillator (ICD)/pacemaker implanted, had fewer cardiovascular risk factors and comorbidities (P < 0.001). In 28.6% of patients, CMR was used along with transthoracic echocardiography (TTE); 67.6% patients underwent TTE alone, and 0.9% only CMR.
Less than one-third of patients enrolled in the registry underwent CMR and the use varied greatly between cardiomyopathy subtypes, clinical profiles of patients, and European tertiary referral centres. This gap with current guidelines needs to be considered carefully by scientific societies to promote wider availability and use of CMR in patients with cardiomyopathies.
心脏磁共振（CMR）推荐用于心肌病的诊断，但该方法耗时、昂贵，且在一些欧洲地区的应用受限。本研究旨在确定欧洲心脏病学会（ESC）心肌病注册研究[欧洲观察性研究计划（EORP）的一部分]中纳入的心肌病患者中 CMR 的使用情况。
研究共纳入 3208 例连续成年心肌病患者（34.6%为女性；中位年龄：53.0±15 岁）：1260 例扩张型心肌病（DCM）、1739 例肥厚型心肌病（HCM）、66 例限制型心肌病（RCM）和 143 例致心律失常性右室心肌病（ARVC）。仅 29.4%的患者在基线时进行了 CMR 扫描。根据心肌病亚型，CMR 的使用情况存在差异：ARVC 为 51.1%，RCM 为 36.4%，HCM 为 33.8%，DCM 为 20.6%（P<0.001）。位于不同欧洲国家的三级转诊中心的 CMR 使用情况从 1%到 63.2%不等。行 CMR 的患者更年轻、症状较轻、植入植入式心脏复律除颤器（ICD）/起搏器的比例较低、心血管危险因素和合并症较少（P<0.001）。28.6%的患者同时进行了经胸超声心动图（TTE）和 CMR；67.6%的患者仅行 TTE，0.9%的患者仅行 CMR。
注册研究中不足三分之一的患者接受了 CMR，且该方法在心肌病亚型、患者临床特征和欧洲三级转诊中心之间的使用差异很大。这与当前指南之间存在差距，需要由科学协会仔细考虑，以促进 CMR 在心肌病患者中的更广泛应用。
