Cardiac imaging enhances detection of specific HF diagnoses compared with ECG

Routine use of cardiac magnetic resonance (CMR) imaging is not superior to a selective use strategy in terms of refining the clinical categorization of heart failure (HF) aetiology in patients with nonischaemic HF, a study reports. However, CMR improves the detection of specific HF diagnoses compared with echocardiography (ECG), and specific HF aetiologies are associated with poor outcomes.

The study randomized 500 patients with nonischaemic HF (mean age, 59 years; 68.8 percent male) to undergo routine or selective CMR. Patients in the routine strategy underwent ECG and CMR whereas those assigned to selective use underwent ECG with or without CMR based on the clinical presentation. HF aetiology classification was done according to the imaging data, as well as by the treating physician at 3 months (primary outcome). Clinical events were collected for 12 months.

Rates of specific HF aetiologies at the 3-month follow-up were similar in the routine and selective CMR strategies (44 percent vs 50 percent, respectively; p=0.22). Likewise, the rates did not significantly differ on clinical assessment (34 percent vs 30 percent, respectively; p=0.34). However, a nonprotocol CMR was performed for 24 percent of patients in the selective group.

The frequency of clinical events was higher among patients with specific vs nonspecific HF aetiologies based on imaging classification (19 percent vs 12 percent, respectively; p=0.02) but not on clinical assessment (15 percent vs 14 percent; p=0.49).

The findings confirm that CMR should not be used routinely for diagnosing undifferentiated, nonischaemic HF, according to researchers. Additional studies are needed to evaluate the imaging modality’s role in specific nonischaemic populations, including patients with suspected inflammatory and infiltrative myocardial disease.