P754Familiarity and perceptions of Portuguese cardiologists on cardiovascular magnetic resonance and cardiac computed tomography - dimension of the task ahead


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Abstract

Background: Cardiovascular magnetic resonance (CMR) and coronary CT angiography (CCTA) are now established diagnostic tools in cardiovascular disease. However, their relative youth and rapid evolution pose challenges to practicing physicians in terms of awareness of their indications, contraindications, advantages and pitfalls.Methods:We conducted a nationwide online survey assessing the familiarity, perceptions and patterns of use of these newer imaging modalities using an anonymized questionnaire sent to all members of the Portuguese Society of Cardiology.Results:The questionnaire was completed by 149 practicing physicians (127 cardiologists, 96 male, mean age 47±11 years). Half of them reported requesting at least one CMR (52%) or CCTA (51%) per week, but only 19% request a coronary calcium score (CCS) at least once weekly. Cardiac masses, congenital heart disease and cardiomyopathies are all considered good or excellent indications for CMR by over 90% of responders, while viability assessment and acute myocardial infarction with normal coronary arteries are considered good or excellent indications by 73% and 68% of responders, respectively. Suspected coronary artery disease in symptomatic patients with intermediate pretest probability is considered a good or excellent indication for CCTA by 61% of responders when performed as a second line examination, and by 28% of responders as a first line test. 30% of the inquired physicians think that the evaluation of coronary stents is a good or excellent indication for CCTA.Less than half (44%) answered correctly all the questions regarding contraindications of CMR, and 23% fail to recognize CMR as a method devoid of ionizing radiation. The main reasons for not referring a patient for CMR were limited availability (45%) and cost (34%). Regarding cost, 66% of responders think that CCTA is more costly than stress SPECT and invasive coronary angiography (ICA). CMR is considered more expensive than stress SPECT and ICA by 68% and 51% of responders, respectively. As for radiation, 12% of responders think that CCTA has a higher mean radiation dose compared to stress SPECT, and 50% consider it higher compared to ICA.Conclusions: Portuguese cardiologists seem only moderately aware of the indications, contraindications and advantages of the newer imaging modalities. Greater efforts should be done to improve physician education on this subject and translate it into improved patient care.

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