Oral Abstract Session
SCMR 22nd Annual Scientific Sessions
CMR is the gold standard test for cardiac structure and function, adding additional incremental value by imaging key processes such as myocardial scar and infiltration (eg by iron).1 However, it is perceived and typically implemented as a complex study that, for most of the world, is out of reach. We have previously shown that focused rapid CMR with an 11 minute (non-contrast) or 18 minute (contrast) protocols is achievable in single developing countries, when accompanied by a training and education programme. We explore delivery now on a multi-national scale.
Building on high-input, initial work in Thailand and Peru, we created an International partnership (UK, USA, Peru, Brazil, India) at an academic level (UK: UCL Global Engagement Office and UCLH Charity; Argentina: Argentinian Societies of Cardiology and Radiology; Peru: Peruvian Society of Cardiology and Peruvian Scientific Council and India: Indian Thalassemics Society. We deployed a previously developed rapid CMR protocol (cardiac volumes, function and either liver iron level1 or LGE2 Figure 1 in Argentina (3 centers), Peru (2 centers) and India (1 center) accompanied by a program of education, training for local cardiologists, radiologists and technologists, embedding results in patient care. All scans were reported by a level 3 SCMR expert.
146 Rapid CMR scans were performed at 6 centers in 3 developing countries:126 contrast studies in Peru (39%) and Argentina (47%); and 20 iron non-contrast studies in India (14%). The visiting training teams for this interaction were smaller and more sustainable than initial pathfinder studies. Average patient age was 54 years, 86% were under local cardiology. 8% had previously undergone CMR. There were no scan-related complications. 97% of scans were diagnostic. All patients with a contrast CMR scan had at least one baseline 2D echocardiogram before CMR. Average scan duration was 24±6mins for contrast studies and 12±3min for the T2* protocol. The most common diagnoses were: 52% non-ischemic cardiomyopathy (22% HCM, 19% DCM, 16% iron overload) and 44% ischemic cardiomyopathy. Significant impact on patient management included new diagnoses (19%) and therapy change (42%), figures 2 and 3. Two CMR naive participating centers (1 Peru 1 India) continued the program delivering a sustained rapidCMR service.
Rapid CMR in the developing world is feasible and changes care, mainly for ischemic and non-ischemic cardiomyopathy when enabled with education and training. Implementation can be done with a small outreach team generating sustainable change; this approach is more deliverable and preserves quality and clinical impact, but results in slightly longer scan duration.