Cardiac Magnetic Resonance versus Echocardiography: An analysis examining risk reclassification by left ventricular ejection fraction and cost burden analysis.
Annie J Tsay, Kinpritma Sangha, Linda Lee, Shuo Wang, Seban Liu, Arslan Zahid, Maria Poonawalla, Roberto M Lang, Christopher M Kramer, Amit R Patel
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引用次数: 0
Abstract
Background: Heart failure (HF) is a leading cause of morbidity and mortality in the United States and is projected to increase in the next decade. Left ventricular ejection fraction (LVEF) is used to guide optimal medical therapy and is typically quantified using 2D-transthoracic echocardiography (TTE) due to ease of accessibility and cost. However, LVEF measurements by cardiac magnetic resonance (CMR) are considered the gold standard due to their accuracy and precision. Despite this, CMR is not the first imaging modality selected for LVEF evaluation due to perceptions of long study time, high cost, and inaccessibility. Our study aims to determine the cost of imaging studies (eg, CMR, TTE) relative to the overall HF-related healthcare costs and associated outcomes.
Methods: A retrospective single-center cohort study of 420 participants with same day TTE and CMR from 2009-2019 including participants >18 years of age with good image quality with or at risk for cardiovascular disease. Primary outcome was a composite outcome defined as HF admission, left ventricular assist device (LVAD), cardiovascular disease-related death, heart transplantation, and implantable cardioverter defibrillator (ICD) implantation. HF risk groups were determined based on clinically relevant LVEF cutoffs. All costs were calculated and adjusted to 2022 US$.
Results: Participants were 49±17 years old, 52% female, 50% White, and 41% Black. Median follow-up was 4 years. HF was the most common co-morbidity (31%). LVEF measured by CMR predicted HF outcomes better than TTE (p=0.005). Continuous net reclassification index of CMR LVEF was 0.36, (95% CI: 0.16-0.56); p=0.001 due to predominant reclassification to lower risk groups. On an individual level, HF healthcare cost increased from low to high-risk groups irrespective of modality. High-risk individuals classified by CMR had lower average per person HF healthcare costs compared to TTE counterparts. Cost of CMR and TTE was < 1% of the total HF healthcare cost.
Conclusions: The cost of non-invasive imaging studies accounted for <1% of the cost compared to other components of HF care. Downstream cost prediction based on LVEF classification using CMR has the potential to better predict cost burden compared to TTE in patients with HF.
期刊介绍:
Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to:
New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system.
New methods to enhance or accelerate image acquisition and data analysis.
Results of multicenter, or larger single-center studies that provide insight into the utility of CMR.
Basic biological perceptions derived by CMR methods.