Circulation. 2006;114:1225
(Circulation. 2006;114:1225.)
© 2006 American Heart Association, Inc.
Issue Highlights
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CLINICAL UTILITY AND SAFETY OF A PROTOCOL FOR NONCARDIAC AND CARDIAC MAGNETIC RESONANCE IMAGING OF PATIENTS WITH PERMANENT PACEMAKERS AND IMPLANTABLE CARDIOVERTER DEFIBRILLATORS AT 1.5 TESLA, by Nazarian et al.
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and
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STRATEGY FOR SAFE PERFORMANCE OF EXTRATHORACIC MAGNETIC RESONANCE IMAGING AT 1.5 TESLA IN THE PRESENCE OF CARDIAC PACEMAKERS IN NON–PACEMAKER-DEPENDENT PATIENTS: A PROSPECTIVE STUDY WITH 115 EXAMINATIONS, by Sommer et al.
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Parallel with the evolution of clinically useful applications
of magnetic resonance imaging (MRI), there is an increasing
population of patients considered to have a contraindication
to having an MRI study, i.e. those with internal devices such
as pacemakers or implantable defibrillators. This issue is especially
prevalent among patients with heart failure and LV dysfunction,
based on the evidence for biventricular pacing as well as defibrillators.
Small series have suggested that there may be some patients
with devices who can safely undergo an MRI study. Two papers
in this issue of
Circulation advance the knowledge regarding
this controversy, incorporating novel approaches. Sommer and
colleagues report on 82 patients with pacemakers having nonthoracic
MRI studies after prophylactic preprogramming of the pacemakers.
This study assessed post-MRI pacemaker function, measured troponin
levels as an indicator of thermal injury, and followed short-term
outcomes to suggest that selected patients with devices, given
specific pre-MRI programming, can safely undergo MRI. Nazarian
and colleagues follow their recently published
Circulation study
assessing safety of selected devices for cardiac MRI in animal
models by now reporting on 55 patients who had the same devices
undergoing cardiac MRI, which was shown to be safe. The authors’
conclusions involve the relative safety given specific preimaging
programming and the predefined device selectivity. These 2 studies
together provide safety information on over 100 patients with
devices having MRI studies. At what point can clinicians feel
comfortable with the safety data? This question is addressed
from a regulatory perspective in an accompanying editorial by
Faris and Shein. They sound a cautionary note, reminding us
that low-frequency safety problems may require substantially
more data to reach rigorous conclusions. Nonetheless, they also
recognize that the data from these papers can begin to inform
a risk-benefit equation for clinicians whose patients with devices
may be faced with a situation where unique information from
MRI may be critically needed for a clinical decision. See pp
1277 and 1285 (and editorial on p
1232).
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COST-EFFECTIVENESS OF CORONARY ARTERY BYPASS GRAFTS VERSUS PERCUTANEOUS CORONARY INTERVENTION FOR REVASCULARIZATION OF HIGH-RISK PATIENTS, by Stroupe et al.
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In current clinical practice, coronary revascularization procedures
are performed with increasing frequency. Inherent in the rise
of the number of these procedures is the associated cost, estimated
to range from $12 billion to $20 billion dollars. Although percutaneous
coronary intervention (PCI) incurs lower initial costs than
coronary artery bypass grafting (CABG), PCI has been associated
with the need for repeat revascularization procedures suggesting
that the total net costs over time may be similar to CABG. In
this issue of
Circulation, Stroupe et al perform a cost-effectiveness
analysis using the Angina With Extremely Serious Operative Mortality
Evaluation (AWESOME) trial data from the Department of Veteran
Affairs. This unique data set, with 5 years of clinical follow-up,
provides insight into the cost-effectiveness of PCI compared
with that of CABG in a high-risk patient population. See p
1251.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Angiographic Computed Tomography for Imaging of Underdeployed
Intracranial Stent. See p
e499.
Coronary Collaterals in Full Effect. See p e501.
Cannulation of a Persistent Left Superior Vena Cava: A Clue Given by ECG Guidance. See p e503.
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Book Review
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Cardiac Catherization in Congenital Heart Disease: Pediatric
and Adult. See p
e505.
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Correspondence
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See p
e506.
Related Articles:
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Food and Drug Administration Perspective: Magnetic Resonance Imaging of Pacemaker and Implantable Cardioverter-Defibrillator Patients
- Owen P. Faris and Mitchell Shein
Circulation 2006 114: 1232-1233.
[Full Text]
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Angiographic Computed Tomography for Imaging of Underdeployed Intracranial Stent
- Goetz Benndorf, Richard P. Klucznik, and Charles M. Strother
Circulation 2006 114: e499-e500.
[Full Text]
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Coronary Collaterals in Full Effect
- Paul Knaapen, Lucas J. Klein, Robin Nijveldt, Tjeerd Germans, Albert C. van Rossum, and Carel C. de Cock
Circulation 2006 114: e501-e502.
[Full Text]
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Cannulation of a Persistent Left Superior Vena Cava: A Clue Given by ECG Guidance
- Wolfram Schummer and Claudia Schummer
Circulation 2006 114: e503-e504.
[Full Text]
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Cardiac Catheterization in Congenital Heart Disease: Pediatric and Adult
- James E. Lock and Audrey C. Marshall
Circulation 2006 114: e505.
[Full Text]
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Letter by Romanens and Miserez Regarding Article, "Effect of Intensive Versus Standard Lipid-Lowering Treatment With Atorvastatin on the Progression of Calcified Coronary Atherosclerosis Over 12 Months: A Multicenter, Randomized, Double-Blind Trial"
- Michel J. Romanens and André R. Miserez
Circulation 2006 114: e506.
[Full Text]
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Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients
- Kevin T. Stroupe, Douglass A. Morrison, Mark A. Hlatky, Paul G. Barnett, Lishan Cao, Christopher Lyttle, Denise M. Hynes, William G. Henderson for the Investigators of Veterans Affairs Cooperative Studies Program #385 (AWESOME: Angina With Extremely Serious Operative Mortality Evaluation)
Circulation 2006 114: 1251-1257.
[Abstract]
[Full Text]
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