Pediatric Heart Disease
Hannah Jacobs, DO
Advanced Noninvasive Cardiac Imaging Fellow
Nationwide Children's Hospital, United States
Hannah Jacobs, DO
Advanced Noninvasive Cardiac Imaging Fellow
Nationwide Children's Hospital, United States
Matthew Cornicelli, MD
Assistant Professor of Pediatrics
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
Shae Merves, MD
Assistant Professor
University of Arkansas for Medical Sciences, United States
Ruchira Garg, MD
Professor
Cedars-Sinai Medical Center
Los Angeles, California, United States
Mehul D. Patel, MD
Assistant Professor
The University of Texas Health Science Center at Houston
Houston, Texas, United States
Arpit Kumar Agarwal, MD, MSc, FSCMR
Assistant Professor of Pediatrics, Medical Director Advanced Cardiac Non-Invasive Imaging and 3D
The Children's Hospital of San Antonio
San Antonio, Texas, United States
Nilanjana Misra, MD
Pediatric Cardiologist
Cohen Children's Medical Center
New Hyde Park, New York, United States
Michael P. DiLorenzo, MD MSCE
Assitant Professor of Pediatrics
Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian
New York, New York, United States
Michael Jay Campbell, MD, MHA
Professor of Pediatric Cardiology
Duke University
Durham, North Carolina, United States
Jeremy M. Steele, MD
Assistant Professor of Pediatrics and Radiology and Biomedical Imaging
Yale University
Guilford, Connecticut, United States
Jennifer Co-Vu, MD
Associate Professor
University of Florida
Gainesville, Florida, United States
Joshua D. Robinson, MD
Pediatric Cardiologist
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
Jonathan H. Soslow, MD, MSc
Associate Professor of Pediatrics, and Director, Pediatric Cardiac Imaging Research Center
Vanderbilt University Medical Center
Nashville, United States
Jason N. Johnson, MD
Associate Chief, Pediatric Cardiology
Le Bonheur Children's Hospital
Memphis, Tennessee, United States
Simon Lee, MD
Assistant Professor of Pediatrics
Nationwide Children's Hospital
Columbus, Ohio, United States
The 2018 revised Lake Louise Criteria (rLLC) incorporated parametric mapping by cardiovascular MRI (CMR), to improve diagnostic yield for myocarditis. Society consensus statements have endorsed parametric mapping in the diagnosis of myocarditis in children. Our goal is to characterize clinical CMR and parametric mapping practice patterns worldwide.
Methods:
The CERAMICi Consortium (Cardiovascular Magnetic Resonance Evaluation in Return to Athletes for Myocarditis in COVID-19 and Immunization) created a REDCap survey to evaluate clinical practice patterns for diagnosis of myocarditis in pediatrics. This survey was distributed to the SCMR community and 32 responses were received. Responses were divided by region (International versus North America) and CMR volume (small < 251, medium 251 – 500, large >500 CMR/year). Differences between responses were compared using chi-square test with p< 0.05 considered statistically significant.
Results:
Out of 32 responses, 12 centers were International (3 Asian, 8 European, 1 South American) and 20 centers were North American. 20 centers (63%) used a 1.5T magnet, 5 (16%) used a 3T magnet and 6 (19%) reported using both (with 1 center not responding). 22 centers (69%) reported using rLLC for diagnosis, 6 centers (19%) reported using the original LLC, and 4 centers (13%) reported using a hybrid of both criteria. Fewer small and medium volume centers reported using rLLC exclusively compared to large volume centers, although this did not reach statistical significance (p=0.63, Figure 1). Prevalence of rLLC utilization did not vary across location (International, 8 (67%) and North American, 14 (70%)). Despite only 22 centers (69%) reporting the exclusive use of rLLC for diagnosis, 29 (91%) reported performing T1 mapping. However, only 8 (28%) reported having pediatric scanner-specific normative data and 9 (31%) reported collecting but not clinically reporting T1 mapping data. A range of sources for normative data were cited (Figure 2). 5 centers reported using multiple sources. More North American centers surveyed do not clinically report T1 mapping compared to International centers (8 centers, 44% versus 1 center, 9%, p=0.054). Similarly, 26 centers (81%) reported performing T2 mapping, 10 (38%) of whom do not clinically report T2 values, and only 7 (27%) have pediatric scanner-specific normative data (Figure 2). Another 5 reported utilizing multiple sources of normals. When looking at the importance of cost in CMR utilization, both North American (17, 85%) and International (10, 83%) centers, felt cost was unimportant or somewhat important in obtaining a CMR.
Conclusion:
This survey suggest that the majority of centers perform parametric mapping, however fewer ultimately use the rLLC in diagnosing myocarditis. A small minority of centers reported having pediatric scanner-specific normative data, which likely contributes to underutilization of the rLLC, and highlights an important gap that may aid in the diagnosis of myocardial disease.