Diagnostic accuracy of cardiac magnetic resonance imaging in cardiomyopathies: insights from the University Hospital Centre Zagreb

    Authors

    Keywords

    cardiac magnetic resonance, non-ischemic cardiomyopathy, ischemic cardiomyopathy

    DOI

    https://doi.org/10.15836/ccar2024.492

    Full Text

    **Introduction:** Cardiac magnetic resonance (CMR) imaging has a reported accuracy of 97% in distinguishing between ischemic and non-ischemic heart diseases. However, ischemic patterns are still observed in 6–13% of patients with non-obstructive coronary artery disease. One randomized controlled trial showed that CMR alone identifies the specific cause of non-ischemic heart failure in 36% of cases, a figure that increases to 50% when combined with other clinical information. (1-3) This study aims to evaluate the accuracy of CMR in diagnosing specific non-ischemic cardiomyopathies at the University Hospital Center (UHC) Zagreb. **Methods:** We conducted a retrospective analysis of cardiac MRI scans performed at UHC Zagreb between January and June 2024. The analysis focused on the clinical indications for each scan, the diagnostic findings, and any changes to preliminary diagnoses based on CMR results. **Results:** A total of 92 cardiac MRI scans were successfully performed during the study period. Of these, 50 (54.3%) were performed to investigate the etiology of heart failure or acute myocardial injury in patients with non-obstructive coronary artery disease. The remaining scans assessed ischemia, viability, fibrosis, valvular disease severity, and other conditions. Among the 50 etiology-related scans, 27 (54%) provided a specific diagnosis of non-ischemic cardiomyopathy, 6 (12%) showed ischemic findings despite the absence of significant coronary artery disease, and 17 (34%) did not clarify the etiology. **Conclusion:** Findings suggest that at our tertiary center, the accuracy of CMR in diagnosing the etiology of cardiomyopathies is comparable to that of other institutions. Further improvements in diagnostic outcomes could be realized through enhanced interdisciplinary collaboration between cardiology and radiology teams.

    Literature

    1. Assomull RG, Shakespeare C, Kalra PR, Lloyd G, Gulati A, Strange J, et al. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation. 2011 September 20;124(12):1351–60. https://doi.org/10.1161/CIRCULATIONAHA.110.011346
    2. Paterson DI, Wells G, Erthal F, Mielniczuk L, O’Meara E, White J, et al. OUTSMART HF: A Randomized Controlled Trial of Routine Versus Selective Cardiac Magnetic Resonance for Patients With Nonischemic Heart Failure (IMAGE-HF 1B). Circulation. 2020 March 10;141(10):818–27. https://doi.org/10.1161/CIRCULATIONAHA.119.043964
    3. Kim EK, Chang SA, Choi JO, Glockner J, Shapiro B, Choe YH, et al. Concordant and Discordant Cardiac Magnetic Resonance Imaging Delayed Hyperenhancement Patterns in Patients with Ischemic and Non-Ischemic Cardiomyopathy. Korean Circ J. 2016 January;46(1):41–7. https://doi.org/10.4070/kcj.2016.46.1.41
    Cardiologia Croatica
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    Diagnostic accuracy of cardiac magnetic resonance imaging in cardiomyopathies: insights from the University Hospital Centre Zagreb

    Extended Abstract
    Issue11-12
    Published
    Pages492
    PDF via DOIhttps://doi.org/10.15836/ccar2024.492
    cardiac magnetic resonance
    non-ischemic cardiomyopathy
    ischemic cardiomyopathy

    Authors

    Antun Zvonimir Kovač*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Denis DošenORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Irena Ivanac VranešićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Kristina Marić BešićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja Hrabak PaarORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Miroslav MuršićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: azkovac@gmail.com

    Full Text

    Introduction: Cardiac magnetic resonance (CMR) imaging has a reported accuracy of 97% in distinguishing between ischemic and non-ischemic heart diseases. However, ischemic patterns are still observed in 6–13% of patients with non-obstructive coronary artery disease. One randomized controlled trial showed that CMR alone identifies the specific cause of non-ischemic heart failure in 36% of cases, a figure that increases to 50% when combined with other clinical information. (1–3) This study aims to evaluate the accuracy of CMR in diagnosing specific non-ischemic cardiomyopathies at the University Hospital Center (UHC) Zagreb.

    Methods: We conducted a retrospective analysis of cardiac MRI scans performed at UHC Zagreb between January and June 2024. The analysis focused on the clinical indications for each scan, the diagnostic findings, and any changes to preliminary diagnoses based on CMR results.

    Results: A total of 92 cardiac MRI scans were successfully performed during the study period. Of these, 50 (54.3%) were performed to investigate the etiology of heart failure or acute myocardial injury in patients with non-obstructive coronary artery disease. The remaining scans assessed ischemia, viability, fibrosis, valvular disease severity, and other conditions. Among the 50 etiology-related scans, 27 (54%) provided a specific diagnosis of non-ischemic cardiomyopathy, 6 (12%) showed ischemic findings despite the absence of significant coronary artery disease, and 17 (34%) did not clarify the etiology.

    Conclusion: Findings suggest that at our tertiary center, the accuracy of CMR in diagnosing the etiology of cardiomyopathies is comparable to that of other institutions. Further improvements in diagnostic outcomes could be realized through enhanced interdisciplinary collaboration between cardiology and radiology teams.

    Literature

    1. 1.
      Assomull RG, Shakespeare C, Kalra PR, Lloyd G, Gulati A, Strange J, et al. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation. 2011 September 20;124(12):1351–60.DOI
    2. 2.
      Paterson DI, Wells G, Erthal F, Mielniczuk L, O’Meara E, White J, et al. OUTSMART HF: A Randomized Controlled Trial of Routine Versus Selective Cardiac Magnetic Resonance for Patients With Nonischemic Heart Failure (IMAGE-HF 1B). Circulation. 2020 March 10;141(10):818–27.DOI
    3. 3.
      Kim EK, Chang SA, Choi JO, Glockner J, Shapiro B, Choe YH, et al. Concordant and Discordant Cardiac Magnetic Resonance Imaging Delayed Hyperenhancement Patterns in Patients with Ischemic and Non-Ischemic Cardiomyopathy. Korean Circ J. 2016 January;46(1):41–7.DOI