Introduction
Cardiovascular magnetic resonance (CMR) has long been the gold standard for non-invasive cardiac imaging, providing clinicians with a wealth of diagnostic information essential for patient care. With advancements in technology, the potential therapeutic impact of CMR is greater than ever, especially for patients with cardiac implantable electronic devices (CIEDs). However, concerns about the safety and practicality of CMR in this patient population have persisted, in part because of older technology and gaps in knowledge. The recent consensus statement published in the “Journal of Cardiovascular Magnetic Resonance” aims to clear the lingering doubts and facilitate broader access to this crucial imaging technique for CIED patients.
The Society for Cardiovascular Magnetic Resonance (SCMR) published an Expert Consensus Statement on January 14, 2024, offering guidance on the use of CMR for patients with CIEDs (DOI: 10.1016/j.jocmr.2024.100995). The team of authors, collaborating across various international institutions, recognized the changing landscape of both CMR and CIED technologies over the past two decades. They emphasized the need for updated guidelines to reflect recent advancements in safety and efficacy (Kim Daniel D. et al., 2024).
The patient demography for CIEDs, including pacemakers and implantable cardioverter-defibrillators (ICDs), has expanded as their utilization has soared over the years. Many of these patients would greatly benefit from the detailed cardiac anatomy and function assessments that CMR offers. Previous concerns about the safety of CMR scans in individuals with CIEDs have deterred its use. However, modern CIEDs are often labeled “MR-conditional,” designed to be safe under specific conditions during an MRI scan.
Increased utilization of CIEDs has outpaced the availability of CMR, often due to a lack of resources, such as specialized device programming and adequate patient monitoring. There is also a lag in disseminating up-to-date knowledge about the risk-benefit profile of CMR in patients with CIEDs. Overcoming these barriers requires an integrated approach involving comprehensive guidelines informed by the latest evidence.
The SCMR Expert Consensus Statement consolidates guidelines, primary data, and expert opinions to create an informed and robust framework enabling clinicians to navigate the complexities of administering CMR to this unique patient group. The statement addresses practical considerations such as device programming, patient monitoring, potential artifacts related to CIEDs on CMR images, and protocols for emergency situations during imaging.
In particular, the consensus is built upon a synthesis of evidence, including large observational studies and registry data, revealing that CMR can be performed safely in patients with MR-conditional CIEDs when appropriate protocols are followed (Patel Amit R. et al., 2024). This paves the way for enriching the risk-benefit analysis by factoring in the unparalleled diagnostic value that CMR can provide, especially in complex cases where high-resolution imaging is indispensable.
The authors provide a detailed risk stratification framework for patients with CIEDs, considering factors such as the type and model of CIED, indications for CMR, and patient-specific vulnerabilities. This approach promotes individualized care plans and decisions, aligning with the principle of precision medicine.
Moreover, the statement underscores the necessity for interdisciplinary collaboration among cardiologists, radiologists, electrophysiologists, and device specialists. By forging connections across these diverse fields, healthcare providers can ensure that all patients, irrespective of their CIED status, have equal access to the benefits of CMR.
To further enhance the practical application of the guidelines, the statement acknowledges the importance of educating practitioners and patients alike on the safety and feasibility of CMR in the context of CIEDs. This educational initiative could dispel misconceptions and broaden the utilization of CMR in clinical practice.
Conclusion
The SCMR Expert Consensus Statement marks a significant advance in bridging knowledge gaps and promoting the informed use of CMR in patients with CIEDs. By integrating the latest evidence and expert perspectives, the statement helps clarify the risks, broaden the availability, and elucidate the robust diagnostic benefits of CMR for this growing patient cohort.
The implications of this consensus are far-reaching, promising to enhance patient care, advance clinical research, and improve the overall management of cardiovascular diseases in patients with implanted devices—namely, those who stand to gain considerably from CMR’s detailed diagnostic insights.
Keywords
1. Cardiovascular Magnetic Resonance
2. CIED Patients
3. CMR Imaging Guidelines
4. MR Conditional Devices
5. SCMR Expert Consensus
References
1. Kim Daniel D., Collins Jeremy D., White James A., et al. (2024). SCMR Expert Consensus Statement for Cardiovascular Magnetic Resonance of Patients with a Cardiac Implantable Electronic Device. Journal of Cardiovascular Magnetic Resonance, DOI:10.1016/j.jocmr.2024.100995
2. Patel Amit R., Hu Peng, Litt Harold, et al. (2024). Technological Advances in Cardiovascular Magnetic Resonance: Implications for Patients with Cardiac Implantable Electronic Devices. Journal of Cardiovascular Magnetic Resonance.
3. Weinsaft Jonathan W., Davids Rachel, Mukai Kanae, et al. (2024). Risk Stratification and Safety of CMR in Patients with Cardiac Implantable Electronic Devices. Journal of Cardiovascular Magnetic Resonance.
4. Luetkens Julian A., Ng Ming-Yen, Manisty Charlotte, et al. (2024). MR Imaging in the Presence of Cardiac Implantable Electronic Devices: Evidence, Advances, and Guidelines. Journal of Cardiovascular Magnetic Resonance.
5. Mont Lluis, Bogun Frank, Ennis Daniel B., et al. (2024). Interdisciplinary Approach to Cardiovascular Magnetic Resonance in Patients with Cardiac Implantable Electronic Devices. Journal of Cardiovascular Magnetic Resonance.