European Cardiovascular Magnetic Resonance (EuroCMR) registry--multi national results from 57 centers in 15 countries

Oliver Bruder, Anja Wagner, Massimo Lombardi, Jürg Schwitter, Albert van Rossum, Günter Pilz, Detlev Nothnagel, Henning Steen, Steffen Petersen, Eike Nagel, Sanjay Prasad, Julia Schumm, Simon Greulich, Alessandro Cagnolo, Pierre Monney, Christina C Deluigi, Thorsten Dill, Herbert Frank, Georg Sabin, Steffen Schneider, Heiko Mahrholdt, Oliver Bruder, Anja Wagner, Massimo Lombardi, Jürg Schwitter, Albert van Rossum, Günter Pilz, Detlev Nothnagel, Henning Steen, Steffen Petersen, Eike Nagel, Sanjay Prasad, Julia Schumm, Simon Greulich, Alessandro Cagnolo, Pierre Monney, Christina C Deluigi, Thorsten Dill, Herbert Frank, Georg Sabin, Steffen Schneider, Heiko Mahrholdt

Abstract

Background: The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR.

Methods: Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled.

Results: The most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year).

Conclusion: The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

Figures

Figure 1
Figure 1
Political map of Europe visualizing all 57 participating centers in 15 countries.
Figure 2
Figure 2
Kaplan-Meier Survival Curves for the specific protocol “suspected CAD” with regard to death, aborted SCD and non-fatal myocardial infarction. The number of patients at risk is shown at the bottom of the figure.
Figure 3
Figure 3
Kaplan-Meier Survival Curves for the specific protocol “risk stratification HCM” with regard to death, aborted SCD and adequate ICD discharge. The number of patients at risk is shown at the bottom of the figure.

References

    1. Bruder O, Schneider S, Nothnagel D, Dill T, Hombach V, Schulz-Menger J, Nagel E, Lombardi M, van Rossum AC, Wagner A, Schwitter J, Senges J, Sabin GV, Sechtem U, Mahrholdt H. EuroCMR (European cardiovascular magnetic resonance) registry: results of the German pilot phase. J Am Coll Cardiol. 2009;54:1457–66. doi: 10.1016/j.jacc.2009.07.003.
    1. Wagner A, Bruder O, Schneider S, Nothnagel D, Buser P, Pons-Lado G, Dill T, Hombach V, Lombardi M, van Rossum AC, Schwitter J, Senges J, Sabin GV, Sechtem U, Mahrholdt H, Nagel E. Current Variables, Definitions and Endpoints of the European Cardiovascular Magnetic Resonance Imaging Registry. J Cardiovasc Magn Reson. 2009;11:43. doi: 10.1186/1532-429X-11-43.
    1. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48:1475–97. doi: 10.1016/j.jacc.2006.07.003.
    1. Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trusteestask force on standardized protocols. JCMR. 2008;10:35.
    1. Ricciardi MJ, Wu E, Davidson CJ, Choi KM, Klocke FJ, Bonow RO, Judd RM, Kim RJ. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation. 2001;103:2780–3. doi: 10.1161/hc2301.092121.
    1. Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, Klocke FJ, Bonow RO, Kim RJ, Judd RM. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet. 2003;361:374–9. doi: 10.1016/S0140-6736(03)12389-6.
    1. Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000;343:1445–53. doi: 10.1056/NEJM200011163432003.
    1. Klem I, Heitner JF, Shah DJ, Sketch MH Jr, Behar V, Weinsaft J, Cawley P, Parker M, Elliott M, Judd RM, Kim RJ. Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. J Am Coll Cardiol. 2006;47:1630–8. doi: 10.1016/j.jacc.2005.10.074.
    1. Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S, Davis RB. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation. 2006;113:2733–43. doi: 10.1161/CIRCULATIONAHA.105.570648.
    1. Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, Bijsterveld P, Ridgway JP, Radjenovic A, Dickinson CJ, Ball SG, Plein S. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379:453–60. doi: 10.1016/S0140-6736(11)61335-4.
    1. Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J. 2005;26:1461–74. doi: 10.1093/eurheartj/ehi258.
    1. Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H, Fritz P, Klingel K, Kandolf R, Sechtem U. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004;109:1250–8. doi: 10.1161/01.CIR.0000118493.13323.81.
    1. Mahrholdt H, Wagner A, Deluigi CC, Kispert E, Hager S, Meinhardt G, Vogelsberg H, Fritz P, Dippon J, Bock CT, Klingel K, Kandolf R, Sechtem U. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation. 2006;114:1581–90. doi: 10.1161/CIRCULATIONAHA.105.606509.
    1. Friedrich MG, Strohm O, Schulz-Menger J, Marciniak H, Luft FC, Dietz R. Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation. 1998;97:1802–9. doi: 10.1161/01.CIR.97.18.1802.
    1. Cheng AS, Pegg TJ, Karamitsos TD, Searle N, Jerosch-Herold M, Choudhury RP, Banning AP, Neubauer S, Robson MD, Selvanayagam JB. Cardiovascular magnetic resonance perfusion imaging at 3-tesla for the detection of coronary artery disease: a comparison with 1.5-tesla. J Am Coll Cardiol. 2007;49:2440–9. doi: 10.1016/j.jacc.2007.03.028.
    1. Sommer T, Hackenbroch M, Hofer U, Schmiedel A, Willinek WA, Flacke S, Gieseke J, Träber F, Fimmers R, Litt H, Schild H. Coronary MR angiography at 3.0 T versus that at 1.5 T: initial results in patients suspected of having coronary artery disease. Radiology. 2005;234:718–25. doi: 10.1148/radiol.2343031784.
    1. Varga A, Garcia MA, Picano E. Safety of stress echocardiography (from the International Stress Echo Complication Registry) Am J Cardiol. 2006;98:541–3. doi: 10.1016/j.amjcard.2006.02.064.
    1. Gupta NC, Esterbrooks DJ, Hilleman DE, Mohiuddin SM. Comparison of adenosine and exercise thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. The GE SPECT Multicenter Adenosine Study Group. . J Am Coll Cardiol. 1992;19:248–57. doi: 10.1016/0735-1097(92)90474-2.
    1. Lee TH, Boucher CA. Clinical practice. Noninvasive tests in patients with stable coronary artery disease. N Engl J Med. 2001;344:1840–5. doi: 10.1056/NEJM200106143442406.
    1. Jenkins C, Moir S, Chan J, Rakhit D, Haluska B, Marwick TH. Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging. Eur Heart J. 2009;30:98–106.
    1. Miller JM, Rochitte CE, Dewey M. 21. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36. doi: 10.1056/NEJMoa0806576.
    1. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, Scherer M, Bellinger R, Martin A, Benton R, Delago A, Min JK. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52:1724–32. doi: 10.1016/j.jacc.2008.07.031.
    1. Berman DS, Kiat H, Van Train KF, Friedman J, Garcia EV, Maddahi J. Comparison of SPECT using technetium-99 m agents and thallium-201 and PET for the assessment of myocardial perfusion and viability. Am J Cardiol. 1990;66:72E–9. doi: 10.1016/0002-9149(90)90616-9.
    1. Moschetti K, Muzzarelli S, Pinget C, Wagner A, Pilz G, Wasserfallen JB, Schulz-Menger J, Nothnagel D, Dill T, Frank H, Lombardi M, Bruder O, Mahrholdt H, Schwitter J. Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: Application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems. J Cardiovasc Magn Reson. 2012;14(1):36. doi: 10.1186/1532-429X-14-36.
    1. Jahnke C, Nagel E, Gebker R, Kokocinski T, Kelle S, Manka R, Fleck E, Paetsch I. Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation. 2007;115:1769–76. doi: 10.1161/CIRCULATIONAHA.106.652016.
    1. Kelle S, Chiribiri A, Vierecke J, Egnell C, Hamdan A, Jahnke C, Paetsch I, Wellnhofer E, Fleck E, Klein C, Gebker R. Long-term prognostic value of dobutamine stress CMR. JACC Cardiovasc Imaging. 2011;4(2):161–72. doi: 10.1016/j.jcmg.2010.11.012.
    1. Bertaso AG, Richardson JD, Wong DT, Cunnington MS, Nelson AJ, Tayeb H, Williams K, Chew DP, Worthley MI, Teo KS, Worthley SG. Prognostic value of adenosine stress perfusion cardiac MRI with late gadolinium enhancement in an intermediate cardiovascular risk population. Int J Cardiol. 2012. [Epub ahead of print]. .
    1. Bruder O, Wagner A, Jensen CJ, Schneider S, Ong P, Kispert EM, Nassenstein K, Schlosser T, Sabin GV, Sechtem U, Mahrholdt H. Myocardial Scar Visualized by Cardiovascular Magnetic Resonance Imaging Predicts Major Adverse Events in Patients with Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2010;56:875–87. doi: 10.1016/j.jacc.2010.05.007.
    1. O'Hanlon R, Grasso A, Roughton M, Moon JC, Clark S, Wage R, Webb J, Kulkarni M, Dawson D, Sulaibeekh L, Chandrasekaran B, Bucciarelli-Ducci C, Pasquale F, Cowie MR, McKenna WJ, Sheppard MN, Elliott PM, Pennell DJ, Prasad SK. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010;56(11):867–74. doi: 10.1016/j.jacc.2010.05.010.
    1. Green JJ, Berger JS, Kramer CM, Salerno M. Prognostic value of late gadolinium enhancement in clinical outcomes for hypertrophic cardiomyopathy. JACC Cardiovasc Imaging. 2012;5:370–7. doi: 10.1016/j.jcmg.2011.11.021.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する