Routine, selective cardiac MRI confer similar HF etiologies
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Routine cardiac MRI did not result in more specific HF etiologies in patients with nonischemic HF compared with selective cardiac MRI, according to results of the OUTSMART-HF trial published in Circulation.
Patients with specific HF etiologies based on imaging classification had worse outcomes compared with those without HF etiologies, according to the study.
D. Ian Paterson, MD, cardiologist at the Mazankowski Alberta Heart Institute at the University of Alberta in Edmonton, Canada, and colleagues analyzed data from 500 patients (mean age, 59 years; 69% men) with nonischemic HF. Patients were assigned routine cardiac MRI (n = 248) — echocardiographic and cardiac MRI — or selective cardiac MRI (n = 252), defined as echocardiography with or without cardiac MRI.
Researchers selected four time points at which patients would be evaluated including baseline clinical assessment, imaging assessment and follow-up visits at 3 and 12 months. A detailed medical history, prior testing and physical examination were obtained at enrollment to determine a CV profile and HF burden. Etiology of HF was determined at 3 and 12 months.
The primary outcome was defined as the determination of a specific HF etiology at 3 months based on composite clinical information, which included imaging and all clinical record information.
At 3-month clinical follow-up, the rates of specific HF etiologies were similar in the routine and selective cardiac MRI groups (44% vs. 50%, respectively; P = .22). These rates were also similar at image interpretation (34% vs. 30%, respectively; P = .34). Nonprotocol cardiac MRI was performed in 24% of patients assigned selective cardiac MRI.
More clinical events occurred in patients with specific HF etiologies compared with those with nonspecific etiologies according to imaging classification (19% vs. 12%, respectively; P = .02). This was not seen on clinical assessment (15% vs. 14%, respectively; P = .49).
“Further work should evaluate potential biases in clinical decision-making for patients with HF and explore approaches that improve the uptake of imaging results,” Paterson and colleagues wrote. – by Darlene Dobkowski
Disclosures: Paterson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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