Comparison between transthoracic echocardiography and cardiac magnetic resonance imaging in patients status post atrial switch procedure.
OBJECTIVE
This study compares image quality, cost, right ventricular ejection fraction analysis, and baffle visualization between transthoracic echocardiography and cardiac magnetic resonance imaging in those status post atrial switch for transposition of the great arteries.


BACKGROUND
This population requires imaging for serial evaluations. Transthoracic echocardiography is often first line but has drawbacks, many of which are addressed by cardiac magnetic resonance imaging.


METHODS
Twelve patients (mean age 25 years) with relatively concurrent (mean 157 days) studies were included. Three separate echocardiography and magnetic resonance imaging physicians independently analyzed baffles, image quality, and right ventricular ejection fractions. Institutional and Medicaid charges were compared.


RESULTS
For right ventricular ejection fraction, echocardiography (36.1%) underestimated cardiac magnetic resonance imaging (47.8%, P = .002). Image quality for transthoracic echocardiography was significantly rated lower than cardiac magnetic resonance imaging (P = .002). Baffles were better seen in cardiac magnetic resonance imaging (transthoracic echocardiography vs. cardiac magnetic resonance imaging: superior vena cava 86% vs. 100% [P = .063]; inferior vena cava 33% vs. 97% [P = .002]; pulmonary vein 92% vs. 100% [P = .250]). Comparing hospital charges and Medicaid reimbursement, transthoracic echocardiography respectively costs 18% and 38% less than cardiac magnetic resonance imaging.


CONCLUSIONS
In conclusion, transthoracic echocardiography underestimated right ventricular ejection fraction compared to cardiac magnetic resonance imaging. Cardiac magnetic resonance imaging had consistently higher image quality and better visualization of the baffles. Cost differences are minimal. We propose that cardiac magnetic resonance imaging be considered first line for imaging in certain patients' status post atrial switch procedure.
Section of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Ind 46202, USA.
Jason G
JG
Ho
Mervyn D
MD
Cohen
Eric S
ES
Ebenroth
Marcus S
MS
Schamberger
Timothy M
TM
Cordes
Matthew T
MT
Bramlet
Roger A
RA
Hurwitz
Tiffanie R
TR
Johnson
D000293:Adolescent; D000328:Adult; D057791:Cardiac Imaging Techniques / Q000191:economics / Q000379:methods* / Q000592:standards; D006348:Cardiac Surgical Procedures; D004452:Echocardiography / Q000191:economics / Q000379:methods* / Q000592:standards; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D017721:Hospital Costs; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000379:methods* / Q000592:standards; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D011667:Pulmonary Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D014188:Transposition of Great Vessels / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D014683:Vena Cava, Superior / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult