Abstract | Objectives: Determination if cardiac MRI is a safe diagnostic tool regarding cardiac disease in everyday clinical practice in old and very old people. Additionally, this study aims to evaluate the validity of the diagnostic data obtained in the cardiac MRI.
Materials and methods: For this study, all patients over 80 years of age who received a cardiac MRI (3T Verio und 1,5T Espree, Siemens, Erlangen, Germany) between February 2014 and November 2021 as part of their inpatient treatment were analyzed retrospectively. The focus of our analysis was on the indication for the MRI, whether the MRI was terminated prematurely by the patient and whether the MRI could be evaluated regarding the medical question.
Results: A total of 1153 patients (567 male, 822.9 years) were included in the final analysis. The age range was between 80 and 100 years. Most patients were between 80 and 89 years old (1118; 97%), fewer patients 90 years (35; 3). The main indications for cardiac MRI were stress testing using adenosine or dobutamine (27.4%; n=316), vitality tests acute or chronic after myocardial infarction (26.4%; n=305), imaging before and after ablation for atrial fibrillation (19.8%, n=228) and myocarditis (18.6%; n=214). The remaining MRI (7.8%) related to less common indications such as tumors, thrombus or systemic diseases. A total of 45 (3.9%) of the MRI examinations were terminated prematurely by the patients. 27 (60%) were females and 18 (40%) males. Mean age in the group of interrupted MRI scans was 84.39 ± 3.445. Most common reasons were according to the patients wish in 62.2% (n=28), 15.6% not specified (n=7), 6.7% angina pectoris (AP) (n=3), 4.4% dyspnea, non-compliance of patient, claustrophobia (n=2), 2.2% multiple artifacts detected already during the time the scans were taken, technical problems, comorbidities, errors in picture reconstruction and a detected contraindication for MRI (n=1). An evaluation in the sense of the question was possible in 1081 (93.8%) of the patients. A limited ability to assess was found in 69 (6%) of the patients. 28 (41.2%) of them were females and 40 (58.8%) were male. Mean age of these patients was 83.044 ± 2.8202. Most common reasons were in 52.9% non-compliance of patient (n=36), 26.5% not clearly specified (n=18), 22.1% arrhythmias (n=15), 16.2% implants (n=11), 5.9% artifacts (eg., movement or other kinds of artifacts) and dyspnea (n=4), 4.4% pleural or pericardial edemas and general bad image quality, 1.5% the area of interest was not clearly visible on the MRI and decompensated heart insufficiency.
Conclusion: Our results indicate that cardiac MRI is a suitable diagnostic tool in old and very old patients because very few patients discontinue the examination early and only a few examinations are evaluable in a limited way. Most cardiac MRI examinations are stress testing, viability assessments, before and after atrial ablation and myocarditis scans. Cardiac MRI should be considered for diagnostics in elderly cardiovascular patients as part of an individual therapy decision in this vulnerable population. |
Abstract (croatian) | Ciljevi: Utvrđivanje je li MRI srca siguran dijagnostički alat za srčane bolesti u svakodnevnoj kliničkoj praksi u starijih i vrlo starih ljudi. Osim toga, ova studija ima za cilj procijeniti valjanost dijagnostičkih podataka dobivenih navedenom metodom.
Materijali i metode: Za ovu studiju retrospektivno su analizirani svi pacijenti stariji od 80 godina kojima je napravljen MRI srca (3T Verio und 1,5T Espree, Siemens, Erlangen, Njemačka) između veljače 2014. i studenog 2021. kao dio bolničkog liječenja. Fokus naše analize bio je na indikaciji za MRI, je li pacijent prerano prekinuo MRI i može li se MRI procijeniti s obzirom na medicinsko pitanje.
Rezultati: Ukupno 1153 bolesnika (567 muškaraca, 82±2,9 godina) uključeno je u konačnu analizu. Raspon godina bio je između 80 i 100 godina. Većina bolesnika bila je u dobi od 80 do 89 godina (1118; 97%), manjina bolesnika ≥90 godina (35; 3). Glavne indikacije za MRI srca bile su testiranje opterećenja adenozinom ili dobutaminom (27,4%; n=316), akutni ili kronični testovi vitalnosti nakon infarkta miokarda (26,4%; n=305), snimanje prije i poslije ablacije zbog fibrilacije atrija (19,8% , n=228) i miokarditis (18,6%; n=214). Preostali MRI (7,8%) odnosio se na manje uobičajene indikacije poput tumora, tromba ili sistemskih bolesti. Pacijenti su prerano prekinuli ukupno 45 (3,9%) MRI pregleda. 27 (60%) su bile žene i 18 (40%) muškarci. Prosječna dob u skupini prekinutih MRI pretraga bila je 84,39 ± 3,445. Najčešći razlozi bili su po želji bolesnika u 62,2% (n=28), 15,6% nespecificirano (n=7), 6,7% angina pektoris (AP) (n=3), 4,4% dispneja, nepristajanje bolesnika , klaustrofobija (n=2), 2,2% višestruki artefakti otkriveni već tijekom vremena snimanja, tehnički problemi, komorbiditeti, pogreške u rekonstrukciji slike i otkrivena kontraindikacija za MRI (n=1). Procjena u smislu pitanja bila je moguća u 1081 (93,8%) pacijenata. Ograničena sposobnost procjene pronađena je u 69 (6%) pacijenata. Od toga je 28 (41,2%) žena i 40 (58,8%) muškaraca. Prosječna dob ovih pacijenata bila je 83,044 ± 2,8202. Najčešći razlozi bili su u 52,9% nesuradljivost pacijenata (n=36), 26,5% nisu jasno navedeni (n=18), 22,1% aritmije (n=15), 16,2% implantati (n=11), 5,9% artefakti (npr. pokreti ili druge vrste artefakata) i dispneja (n=4), 4,4% pleuralni ili perikardijalni edemi i općenito loša kvaliteta slike, 1,5% područje interesa nije bilo jasno vidljivo na MRI i dekompenzirana srčana insuficijencija.
Zaključci: Naši rezultati pokazuju da je magnetska rezonanca srca prikladno dijagnostičko sredstvo u starijih i vrlo starih pacijenata jer vrlo mali broj pacijenata rano prekine pregled i samo je nekoliko pregleda moguće evaluirati na ograničen način. Većina MRI pregleda srca su testiranje opterećenja, procjena vitalnosti, prije i poslije ablacije atrija i skeniranje miokarditisa. MRI srca se kao dijagnostička metoda u starijih kardiovaskularnih bolesnika treba razmotriti kao dio individualne odluke o terapiji u ovoj ranjivoj populaciji. |