Abstract
Errors in identifying the etiology of cardiomyopathy have been described in patients undergoing cardiac transplantation. There are increasing data that cardiovascular magnetic resonance imaging (CMR) provides unique diagnostic information in heart failure. We investigated the association of the performance of CMR prior to cardiac transplantation with rates of errors in identifying the etiology of cardiomyopathy. We compared pre-transplantation clinical diagnoses with post-transplantation pathology diagnoses obtained from the explanted native hearts. Among 338 patients, there were 23 (7%) errors in identifying the etiology of cardiomyopathy. Of these, 22 (96%) occurred in patients with pre-transplantation clinical diagnoses of non-ischemic cardiomyopathy (NICM). Only 61/338 (18%) had CMRs prior to transplantation. There was no significant association between the performance of CMR and errors in the entire study cohort (p = 0.093). Among patients with pre-transplantation clinical diagnoses of NICM, there was a significant inverse association between the performance of CMR and errors (2.4% vs. 14.6% in patients with and without CMR respectively; p = 0.030). In conclusion, CMR was underutilized prior to cardiac transplantation. In patients with pre-transplantation clinical diagnoses of NICM – in whom 96% of errors in identifying the etiology of cardiomyopathy occurred – the performance of CMR was associated with significantly fewer errors.
Highlights
Heart failure is associated with significant mortality, morbidity, and healthcare costs
Errors in identifying the etiology of cardiomyopathy have been described in patients undergoing cardiac transplantation through comparisons of pre-transplantation clinical diagnoses with post-transplantation diagnoses obtained by pathology examination of the explanted native hearts[3,4,5,6,7]
To investigate the impact of Cardiovascular magnetic resonance imaging (CMR), we studied consecutive patients that underwent cardiac transplantation and examined whether the performance of CMR any time prior to transplantation was associated with fewer errors in identifying the etiology of cardiomyopathy
Summary
Heart failure is associated with significant mortality, morbidity, and healthcare costs. Etiology-specific treatment, in addition to standard heart failure therapies, can slow disease progression, reverse myocardial remodeling, and delay or preclude the need for advanced therapies such as cardiac transplantation[2]. Examples of such etiology-specific therapies include: coronary revascularization for ischemic cardiomyopathy (ICM), immunosuppression for inflammatory cardiomyopathies such as cardiac sarcoidosis and giant cell myocarditis, and exercise restriction and implantable cardioverter defibrillators for arrhythmogenic cardiomyopathy[2]. To investigate the impact of CMR, we studied consecutive patients that underwent cardiac transplantation and examined whether the performance of CMR any time prior to transplantation (hereon noted as pre-transplantation CMR) was associated with fewer errors in identifying the etiology of cardiomyopathy
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