Appropriateness of cardiovascular computed tomography and magnetic resonance imaging in patients with conotruncal defects.
Document Type
Article
Publication Date
5-2023
Identifier
DOI: 10.1016/j.jcct.2023.01.044
Abstract
BACKGROUND: To promote the rational use of cardiovascular imaging in patients with congenital heart disease, the American College of Cardiology developed Appropriate Use Criteria (AUC), but its clinical application and pre-release benchmarks have not been evaluated. We aimed to evaluate the appropriateness of indications for cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) in patients with conotruncal defects and to identify factors associated with maybe or rarely appropriate (M/R) indications.
METHODS: Twelve centers each contributed a median of 147 studies performed prior to AUC publication (01/2020) on patients with conotruncal defects. To incorporate patient characteristics and center-level effects, a hierarchical generalized linear mixed model was used.
RESULTS: Of the 1753 studies (80% CMR, and 20% CCT), 16% were rated M/R. Center M/R ranged from 4 to 39%. Infants accounted for 8.4% of studies. In multivariable analyses, patient- and study-level factors associated with M/R rating included: age(OR 1.90 [1.15-3.13]), truncus arteriosus (vs. tetralogy of Fallot, OR 2.55 [1.5-4.35]), and CCT (vs. CMR, OR 2.67 [1.87-3.83]). None of the provider- or center-level factors reached statistical significance in the multivariable model.
CONCLUSIONS: Most CMRs and CCTs ordered for the follow-up care of patients with conotruncal defects were rated appropriate. However, there was significant center-level variation in appropriateness ratings. Younger age, CCT, and truncus arteriosus were independently associated with higher odds of M/R rating. These findings could inform future quality improvement initiatives and further exploration of factors resulting in center-level variation.
Journal Title
J Cardiovasc Comput Tomogr
Volume
17
Issue
3
First Page
211
Last Page
219
MeSH Keywords
Infant; Humans; Predictive Value of Tests; Heart Defects, Congenital; Tomography, X-Ray Computed; Magnetic Resonance Imaging
Keywords
Appropriate use criteria; Cardiac imaging; Cardiovascular computed tomography; Cardiovascular magnetic resonance; Congenital heart disease; Conotruncal defects
Recommended Citation
Pickard SS, Armstrong AK, Balasubramanian S, et al. Appropriateness of cardiovascular computed tomography and magnetic resonance imaging in patients with conotruncal defects. J Cardiovasc Comput Tomogr. 2023;17(3):211-219. doi:10.1016/j.jcct.2023.01.044
COinS
