Reconsider That Cardiac MRI for Some COVID-19 Patients: Healthcare Experts Express Concern and Caution

September 17, 2020

A group of cardiologists, imaging specialists, and general medicine providers offer a warning about using CMR with asymptomatic patients and entreat professional societies from radiology and other specialties to craft guidance on proper usage.

Recent articles that point to evidence of myocarditis found on cardiac MRI (CMR) in patients who have recovered from COVID-19 have included results from scans conducted on asymptomatic individuals. Using these findings as a basis for clinical practice could be leading the healthcare community down a questionable path, a group of experts have said.

In an open letter addressed to the American College of Radiology (ACR), the Radiological Society of North America (RSNA), the European Society of Radiology (ESR), and 15 other professional organizations, a cadre of 50 imaging, cardiology, and general medicine experts, specifically requested that these societies draft guidance that does not recommend CMR for asymptomatic patients.

Their Sept. 15 plea comes in response to recently published research in JAMA Cardiology, as well as other studies, that suggest CMR can play a critical role in pinpointing signs of myocarditis in this patient population.

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“We wish to emphasize that the prevalence, clinical significance, and long-term implications of CMR surrogates of myocardial injury on morbidity and mortality are unknown,” the group wrote. “Further, it is unclear if the elevated T1 and T2 flagged in these studies are clinically significant, particularly in isolation, if treatment is needed, and, if so, what the management should be. These important questions should inspire future prospective studies.”

They also raised concerns about media coverage of the findings, indicating that it has already led to inappropriate use of the study.

“We are aware that some individuals are seeking CMR testing despite the absence of cardiac symptoms,” they wrote. “We believe that, given the preliminary nature and limitations of the current evidence, testing asymptomatic members of the general public after COVID-19 is not indicated outside of carefully planned and approved research studies with appropriate control groups.

Consequently, the letter authors called on the ACR, RSNA, ESR, and other groups to use their influence to provide clarity and guidance on using this scan going forward.

“In light of your societies’ standing in the community and advocacy against low-yield testing and low-value medical care through your sponsorship of the Choosing Wisely, Image Wisely, and other similar campaigns,” they wrote, “we request that you offer clear guidance discouraging CMR screening for COVID-19-related heart abnormalities in asymptomatic members of the general public.”