Abstract 17477: Assessment of Appropriateness of Cardiac Magnetic Resonance Studies at a Tertiary Care Center
Introduction: ACCF/SCMR has published appropriateness criteria for cardiac magnetic resonance (CMR) studies. However, to what extent they cover the range of indications in real world practice and whether they can be reproducibly applied to classify studies is unknown. The aim of this study was to assess clinical application of CMR appropriateness criteria at a tertiary care center.
Methods: Appropriateness criteria were applied to 305 consecutive patients (mean age 54+17 y; 66% males) who presented for CMR from January 2008 to December 2009 at a tertiary care center. Medical records were reviewed by two cardiology fellows to apply the appropriateness criteria and studies were classified as appropriate, inappropriate, uncertain or unclassifiable (if the indication for CMR was not listed in the appropriateness document). In cases of disagreement between fellows, the discrepancy was adjudicated by a senior staff cardiologist.
Results: CMR was most commonly requested for evaluation of pulmonary veins prior to ablation for atrial fibrillation (35%), to assess for arrhythmogenic right ventricular cardiomyopathy (15%) or myocarditis (7%), to better define a possible cardiac/paracardiac mass (7%), or for viability assessment (5%). Overall, 90% of studies were classified as appropriate, 1% as inappropriate, 1% as uncertain and 6.6% were unclassifiable. Among studies categorized as unclassifiable, 40% were ordered for evaluation of aortic disease other than aortic dissection. There was 97% overall level of agreement in characterizing appropriateness between the two physicians (kappa =0.42).
Conclusions: In our single center experience of mostly appropriate CMR studies, there was excellent interrater reliability in characterizing appropriateness among physicians. Approximately one in 20 studies was performed for an indication not directly addressed by the appropriateness document, including aortic disease other than dissection, an indication recently endorsed in the thoracic aortic disease guidelines. Current CMR appropriateness guidelines as written can be applied to classify majority of studies. Efforts should be made to align professional society documents on appropriateness to avoid regulatory and professional confusion.
- © 2010 by American Heart Association, Inc.