OUTSMART HF: A Randomized Controlled Trial of Routine Versus Selective Cardiac Magnetic Resonance for Patients With Nonischemic Heart Failure (IMAGE-HF 1B)
| Autor: | D. Ian Paterson, George Wells, Fernanda Erthal, Lisa Mielniczuk, Eileen O’Meara, James White, Kim A. Connelly, Juhani Knuuti, Miroslaw Radja, Mika Laine, Benjamin J.W. Chow, Riina Kandolin, Li Chen, Alexander Dick, Carole Dennie, Linda Garrard, Justin Ezekowitz, Rob Beanlands, Kwan-Leung Chan, Peter Brown, Juha Kartikainen, Marja Hedman, Eric Larose, Philippe Pibarot, Jean-Claude Tardif, Jonathan Leipsic, Marla Kiess, Andrew Howarth, Helena Hanninen, Lloyd Duchesne, Michael Freeman, Howard Leong-Poi, Graham Wright, Heikki Ukkonen |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Risk medicine.medical_specialty Canada 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Physiology (medical) Internal medicine Medicine Humans 030212 general & internal medicine Aged Heart Failure medicine.diagnostic_test business.industry Diagnostic Tests Routine Magnetic resonance imaging Heart Middle Aged medicine.disease Magnetic Resonance Imaging Survival Analysis Clinical trial Treatment Outcome Echocardiography Heart failure Cardiology Female Cardiology and Cardiovascular Medicine business Cardiac magnetic resonance Follow-Up Studies |
| Zdroj: | Circulation. 141(10) |
| ISSN: | 1524-4539 |
| Popis: | Background: Cardiac magnetic resonance (CMR) is a recommended imaging test for patients with heart failure (HF); however, there is a lack of evidence showing incremental benefit over transthoracic echocardiography. Our primary hypothesis was that routine use of CMR will yield more specific diagnoses in nonischemic HF. Our secondary hypothesis was that routine use of CMR will improve patient outcomes. Methods: Patients with nonischemic HF were randomized to routine versus selective CMR. Patients in the routine strategy underwent echocardiography and CMR, whereas those assigned to selective use underwent echocardiography with or without CMR according to the clinical presentation. HF causes was classified from the imaging data as well as by the treating physician at 3 months (primary outcome). Clinical events were collected for 12 months. Results: A total of 500 patients (344 male) with mean age 59±13 years were randomized. The routine and selective CMR strategies had similar rates of specific HF causes at 3 months clinical follow-up (44% versus 50%, respectively; P =0.22). At image interpretation, rates of specific HF causes were also not different between routine and selective CMR (34% versus 30%, respectively; P =0.34). However, 24% of patients in the selective group underwent a nonprotocol CMR. Patients with specific HF causes had more clinical events than those with nonspecific caused on the basis of imaging classification (19% versus 12%, respectively; P =0.02), but not on clinical assessment (15% versus 14%, respectively; P =0.49). Conclusions: In patients with nonischemic HF, routine CMR does not yield more specific HF causes on clinical assessment. Patients with specific HF causes from imaging had worse outcomes, whereas HF causes defined clinically did not. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01281384. |
| Databáze: | OpenAIRE |
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