Deepak Padmanabhan1, Mary L Jondal1, David O Hodge1, Ramila A Mehta1, Nancy G Acker1, Connie M Dalzell1, Suraj Kapa1, Samuel J Asirvatham1, Yong-Mei Cha1, Joel P Felmlee1, Robert E Watson1, Paul A Friedman2. 1. From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.). 2. From the Division of Cardiovascular Diseases (D.P., N.G.A., C.M.D., S.K., S.J.A., Y.-M.C., P.A.F.), Department of Radiology (M.L.J., J.P.F., R.E.W.), and Division of Biomedical Statistics and Informatics (R.A.M.), Mayo Clinic, Rochester, MN; and Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL (D.O.H.). friedman.paul@mayo.edu.
Abstract
BACKGROUND: Use of magnetic resonance imaging (MRI) brain is restricted in patients with cardiovascular implantable electronic devices (CIEDs). We proposed to determine whether mortality difference exists for patients with non-MRI-conditional CIEDs undergoing brain MRI compared with controls. METHODS AND RESULTS: Retrospective analysis of prospectively collected data was performed to compare all-cause mortality in patients with CIEDs undergoing brain MRI (CIED-MRI) with 3 control groups matched for age, sex, imaging year, and type of CIED: (1) no CIED, brain MRI (no-CIED-MRI); (2) CIED, brain computerized tomography (CT) scan (CIED-CT); and (3) no CIED, brain CT (no-CIED-CT). The primary outcome was a significant difference (P<0.05) between estimated mortality rates. Secondary outcomes were changes in device function before and after brain MRI. The estimated all-cause mortality at 5 years for the CIED-MRI group [mean age (±SD), 68.2 years (15.3 years); 61.2% men] was not significantly different from patients who underwent CT with or without a device (CIED-CT group: hazard ratio, 0.814; 95% confidence interval, 0.593-1.117; P=0.2; no-CIED-CT group: hazard ratio, 1.149; 95% confidence interval, 0.818-1.613; P=0.4). There was a significant increase in mortality between CIED-MRI and no-CIED-MRI groups (hazard ratio, 1.463; 95% confidence interval, 1.019-2.099; P=0.04). CONCLUSIONS: Brain MRI in patients with CIEDs does not carry an increased mortality risk compared with brain CT and can be performed with adherence to appropriate procedural protocols.
BACKGROUND: Use of magnetic resonance imaging (MRI) brain is restricted in patients with cardiovascular implantable electronic devices (CIEDs). We proposed to determine whether mortality difference exists for patients with non-MRI-conditional CIEDs undergoing brain MRI compared with controls. METHODS AND RESULTS: Retrospective analysis of prospectively collected data was performed to compare all-cause mortality in patients with CIEDs undergoing brain MRI (CIED-MRI) with 3 control groups matched for age, sex, imaging year, and type of CIED: (1) no CIED, brain MRI (no-CIED-MRI); (2) CIED, brain computerized tomography (CT) scan (CIED-CT); and (3) no CIED, brain CT (no-CIED-CT). The primary outcome was a significant difference (P<0.05) between estimated mortality rates. Secondary outcomes were changes in device function before and after brain MRI. The estimated all-cause mortality at 5 years for the CIED-MRI group [mean age (±SD), 68.2 years (15.3 years); 61.2% men] was not significantly different from patients who underwent CT with or without a device (CIED-CT group: hazard ratio, 0.814; 95% confidence interval, 0.593-1.117; P=0.2; no-CIED-CT group: hazard ratio, 1.149; 95% confidence interval, 0.818-1.613; P=0.4). There was a significant increase in mortality between CIED-MRI and no-CIED-MRI groups (hazard ratio, 1.463; 95% confidence interval, 1.019-2.099; P=0.04). CONCLUSIONS: Brain MRI in patients with CIEDs does not carry an increased mortality risk compared with brain CT and can be performed with adherence to appropriate procedural protocols.