Noninvasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in low-middle income countries

ABSTRACT

Introduction: Cardiac Magnetic Resonance (CMR) is a crucial diagnostic imaging test that redefines diagnosis and enables targeted therapies, but the access to CMR is limited in low-middle Income Countries (LMICs) even though cardiovascular disease is an emergent primary cause of mortality in LMICs. New abbreviated CMR protocols can be less expensive, faster, whilst maintaining accuracy, potentially leading to a higher utilization in LMICs.

Areas covered: This article will review cardiovascular disease in LMICs and the current role of CMR in cardiac diagnosis and enable targeted therapy, discussing the main obstacles to prevent the adoption of CMR in LMICs. We will then review the potential utility of abbreviated, cost-effective CMR protocols to improve cardiac diagnosis and care, the clinical indications of the exam, current evidence and future directions.

Expert opinion: Rapid CMR protocols, provided that they are utilized in potentially high yield cases, could reduce cost and increase effectiveness. The adoption of these protocols, their integration into care pathways, and prioritizing key treatable diagnoses can potentially improve patient care. Several LMIC countries are now pioneering these approaches and the application of rapid CMR protocols appears to have a bright future if delivered effectively.

KEYWORDS:

• Cardiac MRI
• abbreviated protocols
• low-middle income countries
• cardiomyopathy

Article highlights

• CMR is a key diagnostic imaging test, accepted by international guidelines, that can improve cardiac care for specific indications.

• Rapid CMR protocols could be based on the principle that critical information cannot be obtained by any other imaging modalities: cardiac function, scar assessment and cardiac iron quantification.

• The access of Cardiac Magnetic Resonance is still limited in low-middle income countries, with less data available on the current use of CMR in these countries.

• The adoption of abbreviated CMR protocols can potentially increase access of CMR in LMICs, potentially improving cardiac care.

• There are some pilot studies that have run abbreviated CMR protocols in single centers in LMICs. However, there is still much to do for improving the accessibility of CMR throughout the world.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

KM is funded by The Peruvian Scientific, Technological Development and Technological Innovation (FONDECYT) and Global Engagement Office, University College London. JMW receives support from the National Institute for Health Research University College London Hospitals Biomedical Research Centre and UCLH Charity – Greenbaum/McClean Legacy.