Role of cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology.
Role of cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology.
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DOI：
10.1186/s12968-016-0225-6
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发表时间：
2016-01-22
期刊：
影响因子：
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通讯作者：
Schulz-Menger J
中科院分区：
文献类型：
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作者：
von Knobelsdorff-Brenkenhoff F;Schulz-Menger J
尽管人们对心血管磁共振 (CMR) 充满热情，但其在欧洲的应用却相当多样化。限制归因于多种因素，例如准入有限、培训不足和报销不完整。本研究的目的是对欧洲心脏病学会 (ESC) 指南中 CMR 的表述进行系统总结。筛选了 29 个 ESC 指南中的术语“磁性”、“MRI”、“CMR”、“MR”和“成像”。由于3个主题（心内膜炎、肺动脉高压、NSTEMI）两次发表，最终纳入26个指南。非心血管检查中的 MRI 未被认可。提取了与 CMR 相关的主要结论以及证据水平和推荐类别（如果有）。 26 条指南中有 14 条 (53.8%) 包含有关使用 CMR 的具体建议。 9 项指南 (34.6%) 在文本中提到了 CMR，3 项指南 (11.5%) 没有提及 CMR。 14 条关于 CMR 使用的建议指南包括 39 条 I 类建议、12 条 IIa 类建议、10 条 IIb 类建议和 2 条 III 类建议。大多数建议的证据级别为 C（41/63；65.1%），其次是 B 级（16/63；25.4%）和 A 级（6/63；9.5%）。这四份指南绝对包含了 CMR 的大部分建议，分别是稳定型冠状动脉疾病 (n = 14)、主动脉疾病 (n = 9)、HCM (n = 7) 和心肌血运重建 (n = 7)。 CMR 出现在大多数 ESC 指南中。它们包含许多支持在特定场景中使用 CMR 的建议。必须解决有关获取、培训和报销的问题，才能根据 ESC 指南向患者提供 CMR。
Despite common enthusiasm for cardiovascular magnetic resonance (CMR), its application in Europe is quite diverse. Restrictions are attributed to a number of factors, like limited access, deficits in training, and incomplete reimbursement. Aim of this study is to perform a systematic summary of the representation of CMR in the guidelines of the European Society of Cardiology (ESC). Twenty-nine ESC guidelines were screened for the terms “magnetic”, “MRI”, “CMR”, “MR” and “imaging”. As 3 topics were published twice (endocarditis, pulmonary hypertension, NSTEMI), 26 guidelines were finally included. MRI in the context of non-cardiovascular examinations was not recognized. The main CMR-related conclusions and, if available, the level of evidence and the class of recommendation were extracted. Fourteen of the 26 guidelines (53.8 %) contain specific recommendations regarding the use of CMR. Nine guidelines (34.6 %) mention CMR in the text, and 3 (11.5 %) do not mention CMR. The 14 guidelines with recommendations regarding the use of CMR contain 39 class-I recommendations, 12 class-IIa recommendations, 10 class-IIb recommendations and 2 class-III recommendations. Most of the recommendations have evidence level C (41/63; 65.1 %), followed by level B (16/63; 25.4 %) and level A (6/63; 9.5 %). The four guidelines, which absolutely contained most recommendations for CMR, were stable coronary artery disease (n = 14), aortic diseases (n = 9), HCM (n = 7) and myocardial revascularization (n = 7). CMR is represented in the majority of the ESC guidelines. They contain many recommendations in favour of the use of CMR in specific scenarios. Issues regarding access, training and reimbursement have to be solved to offer CMR to patients in accordance with the ESC guidelines.