心脏磁共振与超声心动图:通过左心室射血分数和成本负担分析检查风险重分类的分析。

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
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

摘要

背景:心力衰竭(HF)是美国发病率和死亡率的主要原因,预计在未来十年将会增加。左心室射血分数(LVEF)用于指导最佳药物治疗,由于易于获取和成本,通常使用2d经胸超声心动图(TTE)进行量化。然而,通过心脏磁共振(CMR)测量LVEF被认为是金标准,因为它们的准确性和精密度。尽管如此,CMR并不是LVEF评估的首选成像方式,因为人们认为CMR的研究时间长、成本高、难以获得。我们的研究旨在确定成像研究(如CMR, TTE)的成本与整体hf相关医疗成本和相关结果的关系。方法:一项回顾性单中心队列研究,纳入2009年至2019年期间420名当日TTE和CMR患者,其中包括bb0至18岁、图像质量良好、患有心血管疾病或有心血管疾病风险的参与者。主要终点是一个复合终点,定义为HF入院、左心室辅助装置(LVAD)、心血管疾病相关死亡、心脏移植和植入式心律转复除颤器(ICD)植入。根据临床相关的LVEF截止值确定HF危险组。所有费用计算并调整为2022美元。结果:参与者年龄49±17岁,女性52%,白人50%,黑人41%。中位随访时间为4年。心衰是最常见的合并症(31%)。CMR测量LVEF预测HF结局优于TTE (p=0.005)。CMR LVEF的连续净再分类指数为0.36,(95% CI: 0.16-0.56);P =0.001,主要是重新分类到低危险组。在个体水平上,HF的医疗费用从低到高危人群增加,与治疗方式无关。根据CMR分类的高危人群,其平均每人HF医疗费用低于TTE对应人群。CMR和TTE的成本低于HF总医疗成本的1%。结论:非侵入性影像学研究的费用占
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cardiac Magnetic Resonance versus Echocardiography: An analysis examining risk reclassification by left ventricular ejection fraction and cost burden analysis.

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.

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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
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.
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