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Current Use of Pediatric Cardiac Magnetic Resonance Imaging in Brazil
Marcelo Felipe Kozak1,2, Jorge Yussef Afiune1, Lars Grosse-Wortmann3,4
1Instituto de Cardiologia do Distrito Federal - Cardiologia Pediátrica, Brasília, DF - Brasil.
Insights
Pediatric cardiac magnetic resonance imaging (CMR) is underutilized in Brazil, with cost and sedation being major barriers. Increased training for pediatric cardiologists can improve complex case utilization.
Area of Science:
- Cardiology
- Pediatric Imaging
- Medical Practice Analysis
Background:
- Limited data exists on pediatric cardiac magnetic resonance imaging (CMR) utilization in Brazil.
- Understanding current practices is crucial for improving pediatric cardiac care.
Purpose of the Study:
- To investigate current pediatric CMR practices in Brazil.
- To identify barriers affecting the use of pediatric CMR.
Main Methods:
- A nationwide survey was distributed to referring physicians.
- Data collected included respondent demographics, CMR practices, patient clinical context, and barriers to CMR use.
- Statistical analysis used a significance level of p < 0.05.
Main Results:
- 142 responses were received; 79% had CMR availability, but 52% rarely or never used it.
- Common indications included cardiomyopathies (84%), post-tetralogy of Fallot repair (81%), and aortic arch malformations (53%).
- High CMR complexity correlated with CMR-to-surgery ratio and exam volume; pediatric cardiologists performing exams increased complexity scores (OR 2.14).
Conclusions:
- Pediatric CMR is infrequently used in Brazil.
- The presence of a pediatric cardiologist performing CMR is linked to its use in more complex cases.
- Enhancing specialist training and educating referring physicians are key to expanding pediatric CMR use in Brazil.
Background:
Data on the use of cardiac magnetic resonance imaging (CMR) on children in Brazil is lacking.
Objectives:
This study sought to provide information on current pediatric CMR practices in Brazil.
Methods:
A questionnaire was sent out to referring physicians around the country. It covered information on the respondents, their CMR practices, the clinical context of the patients, and barriers to CMR use among children. For statistical analysis, two-sided p < 0.05 was considered significant.
Results:
The survey received 142 replies. CMR was reported to be available to 79% of the respondents, of whom, 52% rarely or never use CMR. The most common indications were found to be cardiomyopathies (84%), status of post-tetralogy of Fallot repair (81%), and aortic arch malformations (53%). Exam complexity correlated with CMR-to-surgery ratio (Rho = 0.48, 95% CI = 0.32-0.62, p < 0.0001) and with the number of CMR exams (Rho = 0.52, 95% CI = 0.38-0.64, p < 0.0001). Further, a high CMR complexity score was associated with pediatric cardiologists conducting the exams (OR 2.14, 95% CI 1.2-3.89, p < 0.01). The main barriers to a more frequent use of CMR were its high cost (65%), the need for sedation (60%), and an insufficient number of qualified professionals (55%).
Conclusion:
Pediatric CMR is not used frequently in Brazil. The presence of a pediatric cardiologist who can perform CMR exams is associated with CMR use on more complex patients. Training pediatric CMR specialists and educating referring providers are important steps toward a broader use of CMR in Brazil. (Arq Bras Cardiol. 2021; 116(2):305-312).
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