Title of application - Department of Health | …
MEDICAL SERVICES ADVISORY COMMITTEEMagnetic resonance imaging of patients with suspected non-ischaemic cardiomyopathiesFinal Protocol for Application 1393May 2015Table of Contents TOC \o "1-3" \h \z \u 1.Title of application PAGEREF _Toc418679527 \h 32.Purpose of application PAGEREF _Toc418679528 \h 33.Intervention – proposed medical service PAGEREF _Toc418679529 \h 34.Population and medical condition eligible for the proposed medical services PAGEREF _Toc418679530 \h 74.1Population One PAGEREF _Toc418679531 \h 15Clinical claim for the proposed intervention PAGEREF _Toc418679532 \h 15Comparator(s) PAGEREF _Toc418679533 \h 17Reference standard(s) PAGEREF _Toc418679534 \h 18Clinical pathway PAGEREF _Toc418679535 \h 18Health outcomes PAGEREF _Toc418679536 \h 20Economic evaluation PAGEREF _Toc418679537 \h 20Summary of PICO criteria PAGEREF _Toc418679538 \h 214.2Population Two PAGEREF _Toc418679539 \h 22Clinical claim for the proposed intervention PAGEREF _Toc418679540 \h 22Comparator(s) PAGEREF _Toc418679541 \h 23Reference standard(s) PAGEREF _Toc418679542 \h 23Clinical pathway PAGEREF _Toc418679543 \h 23Economic evaluation PAGEREF _Toc418679544 \h 24Summary of PICO criteria PAGEREF _Toc418679545 \h 254.3Population Three PAGEREF _Toc418679546 \h 26Clinical claim for the proposed intervention PAGEREF _Toc418679547 \h 26Comparator(s) PAGEREF _Toc418679548 \h 27Reference standard(s) PAGEREF _Toc418679549 \h 27Clinical pathway PAGEREF _Toc418679550 \h 28Health outcomes PAGEREF _Toc418679551 \h 29Economic evaluation PAGEREF _Toc418679552 \h 29Summary of PICO criteria PAGEREF _Toc418679553 \h 304.4Population Four PAGEREF _Toc418679554 \h 31Clinical claim for the proposed intervention PAGEREF _Toc418679555 \h 31Comparator(s) PAGEREF _Toc418679556 \h 31Reference standard(s) PAGEREF _Toc418679557 \h 31Clinical pathway PAGEREF _Toc418679558 \h 32Health outcomes PAGEREF _Toc418679559 \h 33Economic evaluation PAGEREF _Toc418679560 \h 33Summary of PICO criteria PAGEREF _Toc418679561 \h 334.5Population Five PAGEREF _Toc418679562 \h 34Clinical claim for the proposed intervention PAGEREF _Toc418679563 \h 34Comparator(s) PAGEREF _Toc418679564 \h 34Reference standard(s) PAGEREF _Toc418679565 \h 35Clinical pathway PAGEREF _Toc418679566 \h 35Health outcomes PAGEREF _Toc418679567 \h 36Economic evaluation PAGEREF _Toc418679568 \h 36Summary of PICO criteria PAGEREF _Toc418679569 \h 365.Fee for the proposed medical service PAGEREF _Toc418679570 \h 376.Healthcare resources PAGEREF _Toc418679571 \h 417.Questions for public funding PAGEREF _Toc418679572 \h 428.References PAGEREF _Toc418679573 \h 47Title of applicationMagnetic resonance imaging of patients with suspected non-ischaemic cardiomyopathies.Purpose of applicationPlease indicate the rationale for the application and provide one abstract or systematic review that will provide background.Cardiac magnetic resonance imaging (CMRI) is a non-invasive imaging technique that utilises radiofrequency signals to image soft tissues. CMRI affords the ability to measure, in one examination, multiple aspects of heart and vascular structure and function. These include, but are not limited to, assessment of left and right ventricular function, myocardial viability, ischaemia assessment, scar assessment, tissue characterisation, imaging of aorta and great vessels, paediatric and adult congenital abnormality imaging, and imaging of the proximal coronary arteries. All of this is achieved without the use of ionising radiation and nephrotoxic contrast media. The ability of CMRI to provide insight into tissue characterisation offers unique information to assist in the diagnosis of diseases of the myocardium, known as cardiomyopathies. This is not routinely available by means other than myocardial biopsy or autopsy.CMRI has been adopted into clinical practice in Europe,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 1 the United Kingdom and the United States. International guidelines from the American College of Cardiology /American Heart Association have recognised over 17 appropriate indications for CMRI, including the evaluation of suspected myocarditis, arrhythmogenic right ventricular cardiomyopathy, restrictive cardiomyopathy, and hypertrophic cardiomyopathy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZW5kZWw8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZW5kZWw8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE.DATA 2 A narrative review by Karamitsos et al (2009) broadly summarises the role of CMRI in determining the underlying aetiology of heart failure due to non-ischaemic cardiomyopathies. ADDIN EN.CITE <EndNote><Cite><Author>Karamitsos</Author><Year>2009</Year><RecNum>40</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>40</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412909033">40</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Karamitsos, T. D.</author><author>Francis, J. M.</author><author>Myerson, S.</author><author>Selvanayagam, J. B.</author><author>Neubauer, S.</author></authors></contributors><auth-address>University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom.</auth-address><titles><title>The role of cardiovascular magnetic resonance imaging in heart failure</title><secondary-title>J Am Coll Cardiol</secondary-title><alt-title>Journal of the American College of Cardiology</alt-title></titles><periodical><full-title>J Am Coll Cardiol</full-title></periodical><pages>1407-24</pages><volume>54</volume><number>15</number><edition>2009/10/03</edition><keywords><keyword>Cardiomyopathies/diagnosis</keyword><keyword>Disease Progression</keyword><keyword>Heart Diseases/*diagnosis</keyword><keyword>Heart Failure/*diagnosis/pathology</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Angiography</keyword><keyword>*Magnetic Resonance Imaging</keyword><keyword>Myocardial Ischemia/diagnosis</keyword><keyword>Myocarditis/diagnosis</keyword><keyword>Prognosis</keyword><keyword>Ventricular Dysfunction, Left/diagnosis/pathology</keyword></keywords><dates><year>2009</year><pub-dates><date>Oct 6</date></pub-dates></dates><isbn>0735-1097</isbn><accession-num>19796734</accession-num><urls></urls><electronic-resource-num>10.1016/j.jacc.2009.04.094</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>3At present, the availability of CMRI in Australia remains restricted due to the lack of a Medicare rebate, with only a small number of public hospitals able to provide this service. It is proposed that expansion of the current MBS services to include these new indications will allow for more accurate diagnosis and prognosis of patients who are suspected of having non-ischaemic cardiomyopathies.Intervention – proposed medical serviceProvide a description of the proposed medical service.MRI utilises strong, uniform magnetic fields to investigate the anatomy, perfusion, tissue characterisation and function of different organs and systems within the human body. When hydrogen protons present in human cells are exposed to this magnetic field, they align along its rotational axis in a uniform plane. In order to generate an image, a sequence of smaller magnetic pulses is targeted towards the area of interest, exciting the protons, which then release radiofrequency signals upon relaxation.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IdW5kbGV5PC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48
UmVjTnVtPjEzPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+
NDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjEzPC9yZWMtbnVtYmVy
Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icjV6enY5OTluejJzZG5ldnp6enZm
ZDBpeDB2enR6ZmR4MHNyIiB0aW1lc3RhbXA9IjE0MTIxMjY1NTAiPjEzPC9rZXk+PC9mb3JlaWdu
LWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250
cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5IdW5kbGV5LCBXLiBHLjwvYXV0aG9yPjxhdXRob3I+
Qmx1ZW1rZSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkZpbm4sIEouIFAuPC9hdXRob3I+PGF1dGhv
cj5GbGFtbSwgUy4gRC48L2F1dGhvcj48YXV0aG9yPkZvZ2VsLCBNLiBBLjwvYXV0aG9yPjxhdXRo
b3I+RnJpZWRyaWNoLCBNLiBHLjwvYXV0aG9yPjxhdXRob3I+SG8sIFYuIEIuPC9hdXRob3I+PGF1
dGhvcj5KZXJvc2NoLUhlcm9sZCwgTS48L2F1dGhvcj48YXV0aG9yPktyYW1lciwgQy4gTS48L2F1
dGhvcj48YXV0aG9yPk1hbm5pbmcsIFcuIEouPC9hdXRob3I+PGF1dGhvcj5QYXRlbCwgTS48L2F1
dGhvcj48YXV0aG9yPlBvaG9zdCwgRy4gTS48L2F1dGhvcj48YXV0aG9yPlN0aWxsbWFuLCBBLiBF
LjwvYXV0aG9yPjxhdXRob3I+V2hpdGUsIFIuIEQuPC9hdXRob3I+PGF1dGhvcj5Xb29kYXJkLCBQ
LiBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48dGl0bGVzPjx0aXRsZT5BQ0NG
L0FDUi9BSEEvTkFTQ0kvU0NNUiAyMDEwIGV4cGVydCBjb25zZW5zdXMgZG9jdW1lbnQgb24gY2Fy
ZGlvdmFzY3VsYXIgbWFnbmV0aWMgcmVzb25hbmNlOiBhIHJlcG9ydCBvZiB0aGUgQW1lcmljYW4g
Q29sbGVnZSBvZiBDYXJkaW9sb2d5IEZvdW5kYXRpb24gVGFzayBGb3JjZSBvbiBFeHBlcnQgQ29u
c2Vuc3VzIERvY3VtZW50czwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5KIEFtIENvbGwgQ2FyZGlv
bDwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogQW0g
Q29sbCBDYXJkaW9sPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MjYxNC02MjwvcGFn
ZXM+PHZvbHVtZT41NTwvdm9sdW1lPjxudW1iZXI+MjM8L251bWJlcj48ZWRpdGlvbj4yMDEwLzA2
LzAyPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5DYXJkaWFjLUdhdGVkIEltYWdpbmcgVGVj
aG5pcXVlczwva2V5d29yZD48a2V5d29yZD5DYXJkaW92YXNjdWxhciBEaXNlYXNlcy8gZGlhZ25v
c2lzPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWduZXRpYyBS
ZXNvbmFuY2UgQW5naW9ncmFwaHk8L2tleXdvcmQ+PGtleXdvcmQ+TWFnbmV0aWMgUmVzb25hbmNl
IEltYWdpbmcvbWV0aG9kcy9zdGFuZGFyZHM8L2tleXdvcmQ+PGtleXdvcmQ+TWFnbmV0aWMgUmVz
b25hbmNlIEltYWdpbmcsIENpbmU8L2tleXdvcmQ+PGtleXdvcmQ+TWFnbmV0aWMgUmVzb25hbmNl
IEltYWdpbmcsIEludGVydmVudGlvbmFsPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFy
PjIwMTA8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5KdW4gODwvZGF0ZT48L3B1Yi1kYXRlcz48L2Rh
dGVzPjxpc2JuPjE1NTgtMzU5NyAoRWxlY3Ryb25pYykmI3hEOzA3MzUtMTA5NyAoTGlua2luZyk8
L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjA1MTM2MTA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0
ZWQtdXJscz48dXJsPmh0dHA6Ly9Db250ZW50Lm9ubGluZWphY2Mub3JnL2RhdGEvSm91cm5hbHMv
SkFDLzIzMjE2LzExMDExLnBkZjwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48Y3VzdG9tMj4z
MDQyNzcxPC9jdXN0b20yPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDE2L2ouamFjYy4y
MDA5LjExLjAxMTwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92
aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFn
ZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgD+AAAA
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IdW5kbGV5PC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48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ADDIN EN.CITE.DATA 4 These signals are converted into an image that represents the concentration of hydrogen protons in tissue, making MRI particularly useful for imaging soft tissues with a high concentration of water.CMRI can be used to discern anatomical features of the heart that can be used to differentiate between cardiomyopathies of varying aetiology. CMRI uses T1, T2, T2* and delayed contrast enhancement sequences to characterise myocardium. ADDIN EN.CITE <EndNote><Cite><Author>Salerno</Author><Year>2009</Year><RecNum>18</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126644">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Salerno, M.</author><author>Kramer, C. M.</author></authors></contributors><titles><title>Advances in Cardiovascular MRI for Diagnostics: Applications in Coronary Artery Disease and Cardiomyopathies</title><secondary-title>Expert Opin Med Diagn</secondary-title></titles><periodical><full-title>Expert Opin Med Diagn</full-title></periodical><pages>673-687</pages><volume>3</volume><number>6</number><edition>2010/11/30</edition><dates><year>2009</year><pub-dates><date>Nov 1</date></pub-dates></dates><isbn>1753-0067 (Electronic)
1753-0059 (Linking)</isbn><accession-num>21113233</accession-num><urls><related-urls><url> Anatomical CMRI protocols include single-shot images to provide localisation of cardiac structures within the heart and great vessels using “dark-blood” or “bright-blood” techniques. Additional sequences in which image contrast is weighted by intrinsic magnetic relaxation times (T1, T2, or T2* relaxation times) are also obtained. ADDIN EN.CITE <EndNote><Cite><Author>Salerno</Author><Year>2009</Year><RecNum>18</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126644">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Salerno, M.</author><author>Kramer, C. M.</author></authors></contributors><titles><title>Advances in Cardiovascular MRI for Diagnostics: Applications in Coronary Artery Disease and Cardiomyopathies</title><secondary-title>Expert Opin Med Diagn</secondary-title></titles><periodical><full-title>Expert Opin Med Diagn</full-title></periodical><pages>673-687</pages><volume>3</volume><number>6</number><edition>2010/11/30</edition><dates><year>2009</year><pub-dates><date>Nov 1</date></pub-dates></dates><isbn>1753-0067 (Electronic)
1753-0059 (Linking)</isbn><accession-num>21113233</accession-num><urls><related-urls><url> Used in combination, CMRI sequences can discern:reduced ejection fraction, typically with global dysfunctionincreased ventricular volumes relative myocardial wall thinninginfiltration, iron loading, inflammation and oedemamyocardial scarring and fibrosisDuring the examination, patients are required to lie in either a prone or supine position within the MRI machine, with as little movement as possible. Images are timed to breath holds, as movement during the imaging procedure can blur the pictures.The magnetic field strength within conventional MRI scanners is either 1.0T (Teslas), 1.5T or 3.0T. The majority of scanners utilise 1.5T fields for CMRI.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS
ZWNOdW0+NDI8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij42
PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+NDI8L3JlYy1udW1iZXI+
PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJyNXp6djk5OW56MnNkbmV2enp6dmZk
MGl4MHZ6dHpmZHgwc3IiIHRpbWVzdGFtcD0iMTQxMzE2NDEyOSI+NDI8L2tleT48L2ZvcmVpZ24t
a2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRy
aWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJydWRlciwgTy48L2F1dGhvcj48YXV0aG9yPlNjaG5l
aWRlciwgUy48L2F1dGhvcj48YXV0aG9yPk5vdGhuYWdlbCwgRC48L2F1dGhvcj48YXV0aG9yPkRp
bGwsIFQuPC9hdXRob3I+PGF1dGhvcj5Ib21iYWNoLCBWLjwvYXV0aG9yPjxhdXRob3I+U2NodWx6
LU1lbmdlciwgSi48L2F1dGhvcj48YXV0aG9yPk5hZ2VsLCBFLjwvYXV0aG9yPjxhdXRob3I+TG9t
YmFyZGksIE0uPC9hdXRob3I+PGF1dGhvcj52YW4gUm9zc3VtLCBBLiBDLjwvYXV0aG9yPjxhdXRo
b3I+V2FnbmVyLCBBLjwvYXV0aG9yPjxhdXRob3I+U2Nod2l0dGVyLCBKLjwvYXV0aG9yPjxhdXRo
b3I+U2VuZ2VzLCBKLjwvYXV0aG9yPjxhdXRob3I+U2FiaW4sIEcuIFYuPC9hdXRob3I+PGF1dGhv
cj5TZWNodGVtLCBVLjwvYXV0aG9yPjxhdXRob3I+TWFocmhvbGR0LCBILjwvYXV0aG9yPjwvYXV0
aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgQ2FyZGlvbG9n
eSBhbmQgQW5naW9sb2d5LCBFbGlzYWJldGggSG9zcGl0YWwsIEVzc2VuLCBHZXJtYW55LiBvLmJy
dWRlckBjb250aWxpYS5kZTwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkV1cm9DTVIgKEV1
cm9wZWFuIENhcmRpb3Zhc2N1bGFyIE1hZ25ldGljIFJlc29uYW5jZSkgcmVnaXN0cnk6IHJlc3Vs
dHMgb2YgdGhlIEdlcm1hbiBwaWxvdCBwaGFzZTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5KIEFt
IENvbGwgQ2FyZGlvbDwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxs
LXRpdGxlPkogQW0gQ29sbCBDYXJkaW9sPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+
MTQ1Ny02NjwvcGFnZXM+PHZvbHVtZT41NDwvdm9sdW1lPjxudW1iZXI+MTU8L251bWJlcj48ZWRp
dGlvbj4yMDA5LzA4LzE4PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZ2VkPC9rZXl3b3Jk
PjxrZXl3b3JkPkNhcmRpb3Zhc2N1bGFyIERpc2Vhc2VzL2RpYWdub3Npczwva2V5d29yZD48a2V5
d29yZD5Db3JvbmFyeSBBcnRlcnkgRGlzZWFzZS8gZGlhZ25vc2lzPC9rZXl3b3JkPjxrZXl3b3Jk
PkV1cm9wZTwva2V5d29yZD48a2V5d29yZD5FeGVyY2lzZSBUZXN0PC9rZXl3b3JkPjxrZXl3b3Jk
PkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5HZXJtYW55PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFu
czwva2V5d29yZD48a2V5d29yZD5NYWduZXRpYyBSZXNvbmFuY2UgQW5naW9ncmFwaHkvbWV0aG9k
czwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9r
ZXl3b3JkPjxrZXl3b3JkPk11bHRpdmFyaWF0ZSBBbmFseXNpczwva2V5d29yZD48a2V5d29yZD5Q
aWxvdCBQcm9qZWN0czwva2V5d29yZD48a2V5d29yZD5Qcm9nbm9zaXM8L2tleXdvcmQ+PGtleXdv
cmQ+UmVnaXN0cmllczwva2V5d29yZD48a2V5d29yZD5SaXNrIEFzc2Vzc21lbnQ8L2tleXdvcmQ+
PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwOTwveWVhcj48cHViLWRhdGVzPjxkYXRlPk9jdCA2
PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTU1OC0zNTk3IChFbGVjdHJvbmljKSYj
eEQ7MDczNS0xMDk3IChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xOTY4MjgxODwvYWNj
ZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYv
ai5qYWNjLjIwMDkuMDcuMDAzPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFi
YXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8
L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU++gAAAA==
ADDIN EN.CITE.DATA 6 The use of higher strength fields allows for images with higher spatial resolution, but also increases the chance of imaging artefacts that may obscure the image.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IdW5kbGV5PC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IdW5kbGV5PC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48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ADDIN EN.CITE.DATA 4Indicate whether the service includes a registered trademark with characteristics that distinguish it from any other similar health technology.The proposed medical service does not include a specific trademarked health technology.Indicate the proposed setting in which the proposed medical service will be delivered and include detail for each of the following as relevant: inpatient private hospital, inpatient public hospital, outpatient clinic, emergency department, consulting rooms, day surgery centre, residential aged care facility, patient’s home, laboratory. Where the proposed medical service will be provided in more than one setting, describe the rationale related to each.Medicare-eligible MRI units are available in public hospitals, private hospitals, and outpatient clinics across Australia. ADDIN EN.CITE <EndNote><Cite><Author>Health</Author><Year>2014</Year><RecNum>46</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>46</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413253813">46</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Department of Health,</author></authors></contributors><titles><title>Magnetic Resonance Imaging</title></titles><volume>2013</volume><number>10 September</number><dates><year>2014</year></dates><pub-location>Canberra</pub-location><publisher>Australian Government</publisher><urls><related-urls><url> The proposed service will be available in each of these settings, subject to the availability of specialised cardiac software and appropriately qualified and experienced staff.Describe how the service is delivered in the clinical setting. This could include details such as frequency of use (per year), duration of use, limitations or restrictions on the medical service or provider, referral arrangements, professional experience required (e.g.: qualifications, training, accreditation etc.), healthcare resources, access issues (e.g.: demographics, facilities, equipment, location etc.).Service duration and frequency A CMRI study consists of approximately 10 minutes for intravenous cannulation and patient safety briefing, 60 to 80 minutes of image acquisition time, 15 to 30 minutes of software analysis time, and 15 to 30 minutes of expert reporting time. The Applicant has suggested that the proposed medical service would be utilised initially as a single, one-off test to determine the underlying aetiology of the cardiomyopathy. There may be some need for longitudinal follow-up in a minority of disease subtypes, or in cases where an unexpected pathology is identified during the scan. Patients are likely to require repeat CMRI studies once every two to five years, but not more than once per year. In the vast majority of patients, limiting the use of CMRI to one scan per 12-month period would be sufficient.EquipmentThe proposed medical service can be conducted using standard whole-body MRI systems utilising specialised cardiac software for quantitative analysis, and either abdominal coils, body coils, thoracic coils or specialised cardiac coils. The choice of coil for CMRI is usually informed by the requirements of each MRI machine. Cardiac software may be incorporated within the scanner; however, third party software that is external to the scanner is more common in clinical practice as scanners are typically occupied during analysis. The use of specialised cardiac coils may offer certain advantages over standard body/thoracic coils, including superior spatial and temporal resolution, as well as decreased image acquisition time; however, Health Expert Standing Panel (HESP), Applicant and public consultation feedback suggests CMRI may be conducted sufficiently with thoracic coils.Co-administered interventionsCMRI investigations that use tissue characterisation and delayed contrast enhancement sequences require the administration of a gadolinium chelate contrast agent, currently listed on the MBS under item number 63491. Delayed contrast-enhanced MRI sequences use a gadolinium-based contrast agent to define the extent of irreversibly damaged myocardium. ADDIN EN.CITE <EndNote><Cite><Author>Medical Advisory Secretariat</Author><Year>2010</Year><RecNum>142</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>142</rec-number><foreign-keys><key app="EN" db-id="f055wwrsv9paxvedtx1xvvazze0zw95trsr9" timestamp="1394587555">142</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Medical Advisory Secretariat,</author></authors></contributors><titles><title>Magnetic resonance imaging (MRI) for the assessment of myocardial viability: an evidence-based analysis</title><secondary-title>Ont Health Technol Assess Ser</secondary-title></titles><periodical><full-title>Ont Health Technol Assess Ser</full-title></periodical><pages>1-45</pages><volume>10</volume><number>15</number><edition>2010/01/01</edition><dates><year>2010</year></dates><isbn>1915-7398 (Electronic)
1915-7398 (Linking)</isbn><accession-num>23074392</accession-num><urls></urls><custom2>3426228</custom2><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>8 The contrast is administered intravenously as a single bolus for tissue characterisation. The total dose is dependent on the type of gadolinium used, and the weight of the patient. In contraindicated patients, the sensitivity for detecting diseases through tissue characterisation would be decreased without the use of a contrast agent. No additional diagnostic tests are considered to be co-administered with CMRI at the time of the scan. General anaesthesia would not commonly be required as part of the proposed service, as patients are required to respond to direction during the imaging.Referral arrangementAlthough general practitioners may refer patients for a limited number of MRI procedures, the Cardiac Society of Australia and New Zealand (CSANZ) recommends that the proposed service should be limited to specialist referral. The proposed service is intended to be used to determine the underlying aetiology of heart failure, which is typically a specialist field. Similarly, specialist referral is required for comparator tests, such as computed tomography coronary angiography (CTCA) (MBS items 57360, 57361), as well as existing CMR services (MBS item 63385). The Applicant further suggests that specialist referral is appropriate given the complexity of the test and the level of understanding required to interpret the test results. Specialist referral is recommended in the guidelines of the National Heart Foundation and the CSANZ for the management of patients with chronic heart failure. ADDIN EN.CITE <EndNote><Cite><Author>Foundation</Author><Year>2011</Year><RecNum>59</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>59</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413497922">59</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>National Heart Foundation,</author></authors></contributors><titles><title>Guidelines for the prevention, detection and management of chronic heart failure in Australia</title></titles><dates><year>2011</year></dates><publisher>National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (Chronic Heart Failure Guidelines Expert Writing Panel)</publisher><urls><related-urls><url> Similarly, guidelines on acute and chronic heart failure produced by the National Institute for Health and Care Excellence (NICE) recommend specialist referral for patients with heart failure and previous myocardial infarction. ADDIN EN.CITE <EndNote><Cite><Author>NICE</Author><Year>2010</Year><RecNum>53</RecNum><DisplayText><style face="superscript">10, 11</style></DisplayText><record><rec-number>53</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413427445">53</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>NICE</author></authors></contributors><titles><title>Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care</title></titles><volume>2014</volume><number>16 October</number><dates><year>2010</year></dates><publisher>National Institue for Health and Care Excellence</publisher><urls><related-urls><url> app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413427362">52</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>NICE</author></authors></contributors><titles><title>Acute heart failure: Diagnosing and managing acute heart failure in adults</title></titles><volume>2014</volume><number>16 October</number><dates><year>2014</year></dates><publisher>National Insitute of Health and Care Excellence</publisher><urls><related-urls><url>, 11 PASC input recommends the list of specialists available to refer patients for CMRI services be open to discussion, but should, as a minimum, include cardiothoracic surgeons and cardiologists.Service provider and accreditationThe Applicant suggests that the proposed service should not be considered a standard radiological procedure due to the complexity of the test in defining cardiac pathologies. Although sufficiently accredited radiologists or cardiologists may report on CMRI images, the proposed service is intended to be utilised primarily by cardiologists. Data from the Euro CMRI registry suggests that only a minority of CMRI scans are reported by radiologists alone (~3%) and that the majority are reported by either cardiologists alone (~75%) or cardiologist / radiologist teams (~20%).PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
ZWNOdW0+NTE8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4x
PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+NTE8L3JlYy1udW1iZXI+
PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJyNXp6djk5OW56MnNkbmV2enp6dmZk
MGl4MHZ6dHpmZHgwc3IiIHRpbWVzdGFtcD0iMTQxMzQyNTQ2OCI+NTE8L2tleT48L2ZvcmVpZ24t
a2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRy
aWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJydWRlciwgTy48L2F1dGhvcj48YXV0aG9yPldhZ25l
ciwgQS48L2F1dGhvcj48YXV0aG9yPkxvbWJhcmRpLCBNLjwvYXV0aG9yPjxhdXRob3I+U2Nod2l0
dGVyLCBKLjwvYXV0aG9yPjxhdXRob3I+dmFuIFJvc3N1bSwgQS48L2F1dGhvcj48YXV0aG9yPlBp
bHosIEcuPC9hdXRob3I+PGF1dGhvcj5Ob3RobmFnZWwsIEQuPC9hdXRob3I+PGF1dGhvcj5TdGVl
biwgSC48L2F1dGhvcj48YXV0aG9yPlBldGVyc2VuLCBTLjwvYXV0aG9yPjxhdXRob3I+TmFnZWws
IEUuPC9hdXRob3I+PGF1dGhvcj5QcmFzYWQsIFMuPC9hdXRob3I+PGF1dGhvcj5TY2h1bW0sIEou
PC9hdXRob3I+PGF1dGhvcj5HcmV1bGljaCwgUy48L2F1dGhvcj48YXV0aG9yPkNhZ25vbG8sIEEu
PC9hdXRob3I+PGF1dGhvcj5Nb25uZXksIFAuPC9hdXRob3I+PGF1dGhvcj5EZWx1aWdpLCBDLiBD
LjwvYXV0aG9yPjxhdXRob3I+RGlsbCwgVC48L2F1dGhvcj48YXV0aG9yPkZyYW5rLCBILjwvYXV0
aG9yPjxhdXRob3I+U2FiaW4sIEcuPC9hdXRob3I+PGF1dGhvcj5TY2huZWlkZXIsIFMuPC9hdXRo
b3I+PGF1dGhvcj5NYWhyaG9sZHQsIEguPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3Jz
PjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBDYXJkaW9sb2d5LCBSb2JlcnQgQm9zY2ggTWVk
aWNhbCBDZW50ZXIsIEF1ZXJiYWNoc3RyYXNzZSAxMTAsIDcwMzc2IFN0dXR0Z2FydCwgR2VybWFu
eS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5FdXJvcGVhbiBDYXJkaW92YXNjdWxhciBN
YWduZXRpYyBSZXNvbmFuY2UgKEV1cm9DTVIpIHJlZ2lzdHJ5LS1tdWx0aSBuYXRpb25hbCByZXN1
bHRzIGZyb20gNTcgY2VudGVycyBpbiAxNSBjb3VudHJpZXM8L3RpdGxlPjxzZWNvbmRhcnktdGl0
bGU+SiBDYXJkaW92YXNjIE1hZ24gUmVzb248L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkpv
dXJuYWwgb2YgY2FyZGlvdmFzY3VsYXIgbWFnbmV0aWMgcmVzb25hbmNlIDogb2ZmaWNpYWwgam91
cm5hbCBvZiB0aGUgU29jaWV0eSBmb3IgQ2FyZGlvdmFzY3VsYXIgTWFnbmV0aWMgUmVzb25hbmNl
PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBDYXJkaW92YXNj
IE1hZ24gUmVzb248L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz45PC9wYWdlcz48dm9s
dW1lPjE1PC92b2x1bWU+PGVkaXRpb24+MjAxMy8wMS8yMjwvZWRpdGlvbj48a2V5d29yZHM+PGtl
eXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5DaGktU3F1YXJlIERpc3RyaWJ1dGlvbjwva2V5
d29yZD48a2V5d29yZD5FdXJvcGU8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxr
ZXl3b3JkPkhlYXJ0IERpc2Vhc2VzLypkaWFnbm9zaXMvbW9ydGFsaXR5L3BhdGhvbG9neS9waHlz
aW9wYXRob2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtl
eXdvcmQ+S2FwbGFuLU1laWVyIEVzdGltYXRlPC9rZXl3b3JkPjxrZXl3b3JkPipNYWduZXRpYyBS
ZXNvbmFuY2UgSW1hZ2luZy9hZHZlcnNlIGVmZmVjdHM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwv
a2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5NeW9jYXJkaXVt
L3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5QcmVkaWN0aXZlIFZhbHVlIG9mIFRlc3RzPC9r
ZXl3b3JkPjxrZXl3b3JkPlByb2dub3Npczwva2V5d29yZD48a2V5d29yZD5SZWdpc3RyaWVzPC9r
ZXl3b3JkPjxrZXl3b3JkPlJpc2sgQXNzZXNzbWVudDwva2V5d29yZD48a2V5d29yZD5SaXNrIEZh
Y3RvcnM8L2tleXdvcmQ+PGtleXdvcmQ+U2V2ZXJpdHkgb2YgSWxsbmVzcyBJbmRleDwva2V5d29y
ZD48a2V5d29yZD5UaXNzdWUgU3Vydml2YWw8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll
YXI+MjAxMzwveWVhcj48L2RhdGVzPjxpc2JuPjEwOTctNjY0NzwvaXNibj48YWNjZXNzaW9uLW51
bT4yMzMzMTYzMjwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGN1c3RvbTI+UG1jMzU2NDc0
MDwvY3VzdG9tMj48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTE4Ni8xNTMyLTQyOXgtMTUt
OTwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08
L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29y
ZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE.DATA 1 It is the intention of the Applicant that the radiologist or cardiologist trained in CMRI be personally available to attend all examinations.Current legislative requirements stipulate that Medicare-eligible MRI items must be reported on by a trained and credentialed specialist in diagnostic radiology. In order to satisfy the Chief Executive of Medicare, the specialist must be a participant in the Royal Australian and New Zealand College of Radiologist's (RANZCR) Quality and Accreditation Program (Health Insurance Regulation 2013 – 2.5.4 – Eligible Providers). ADDIN EN.CITE <EndNote><Cite><Author>Australian Government</Author><Year>2013</Year><RecNum>4</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126317">4</key></foreign-keys><ref-type name="Legal Rule or Regulation">50</ref-type><contributors><authors><author>Australian Government,</author></authors></contributors><titles><title>Health Insurance (Diagnostic Imaging Services Table) Regulation 2013 </title></titles><volume>Division 2.5—Group I5: magnetic resonance imaging</volume><num-vols>2.5.4 MRI and MRA services—eligible provider</num-vols><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote>12 Legislative changes would be required to allow cardiologists to report on CMRI scans, and there would need to be support from the sector for this change to occur. In line with the required legislative changes, the CSANZ recommends consideration towards the development of a Conjoint Accreditation Committee for accreditation of specialists to undertake diagnostic interpretation of CMRI, analogous to the Conjoint Committee for CTCA.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CdWRvZmY8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CdWRvZmY8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFyPjxS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ADDIN EN.CITE.DATA 13 CSANZ would recommend collaboration on this development between CSANZ, RANZCR and the Department. The level of specialist accreditation for CMRI procedures recommended by the Applicant is equivalent to at least Society for Cardiovascular Magnetic Resonance (SCMR) level 2 training. ADDIN EN.CITE <EndNote><Cite><Author>SCMR</Author><Year>2000</Year><RecNum>179</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>179</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413506827">179</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>SCMR</author></authors></contributors><titles><title>Guidelines for credentialing in cardiovascular magnetic resonance (CMR). Society for Cardiovascular Magnetic Resonance (SCMR) Clinical Practice Committee</title><secondary-title>J Cardiovasc Magn Reson</secondary-title><alt-title>Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance</alt-title></titles><periodical><full-title>J Cardiovasc Magn Reson</full-title></periodical><pages>233-4</pages><volume>2</volume><number>3</number><edition>2001/09/08</edition><keywords><keyword>Cardiology/*education</keyword><keyword>Credentialing/*standards</keyword><keyword>Humans</keyword><keyword>*Magnetic Resonance Imaging</keyword><keyword>Nuclear Medicine/*education</keyword><keyword>Radiology/*education</keyword></keywords><dates><year>2000</year></dates><isbn>1097-6647 (Print)
1097-6647</isbn><accession-num>11545122</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>14 These guidelines are broadly applicable, and are consistent with Australian practice. A specific training document for the provision of CMRI services has been developed for Australia by the CSANZ’s Imaging Council. Funding for the proposed service in rural or remote areas should only be provided if suitable MRI hardware and software is available, along with a properly trained and credentialled provider, and appropriately trained radiography staff.Describe any potential risks to the patient. MRI is a non-invasive imaging technique that carries a low risk of complications and adverse events. As MRI utilises magnetic fields to image anatomy and function, patients are not exposed to ionising radiation. The primary cause of direct harm associated with MRI sequencing for cardiomyopathies includes claustrophobia, adverse reactions to contrast agents and patient discomfort due to the noise of the machine. As with all MRI procedures, patients with implantable medical devices that contain metal may be contraindicated for CMRI. However, recent guidelines suggest that CMRI may be performed in patients with implantable cardiac pacing and resynchronisation devices when strict safety protocols are followed.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj52YW4gZGVyIEdyYWFmPC9BdXRob3I+PFllYXI+MjAxNDwv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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj52YW4gZGVyIEdyYWFmPC9BdXRob3I+PFllYXI+MjAxNDwv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ADDIN EN.CITE.DATA 15, 16The incidence of adverse events caused by CMRI procedures was evaluated in the 2009 pilot phase of the European Cardiovascular Magnetic Resonance (EuroCMR) Registry. From a total of 11,040 consecutive CMRI patients, 124 reported mild adverse events, of which 94 were caused by reactions to adenosine and dobutamine stress perfusion agents, 27 were allergic reactions to a contrast agent, and two were unspecified. Five severe complications were reported, including non-sustained ventricular tachycardia, ventricular fibrillation, overt heart failure, and unstable angina. All severe complications were related to the administration of adenosine and dobutamine stress perfusion agents, which are not required for CMRI sequences for cardiomyopathies.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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ADDIN EN.CITE.DATA 6Beyond the direct risks associated with the scan, the main risks associated with the proposed service include physical harms from follow-up testing, and false negative and false positive test results. Estimates of the risks associated with test accuracy will be informed by the assessment.Population and medical condition eligible for the proposed medical servicesProvide a description of the medical condition (or disease) relevant to the service.The term ‘cardiomyopathy’ encompasses a diverse range of diseases of the myocardium that lead to structural and functional impairments in its ability to contract or relax, and which are not caused by coronary artery disease (CAD), hypertension, valvular disease or congenital heart disease. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 These impairments can cause subsequent heart failure, rhythm disturbances and death. The natural history and prognosis of cardiomyopathies varies depending on the underlying aetiology of the disorder. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 Cardiomyopathies can be broadly characterised into five key sub-groups, all of which may benefit from the use of CMRI:Dilated cardiomyopathy (DCM): DCM is reportedly the most common phenotype of cardiomyopathy. It is defined as left ventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions (i.e. hypertension, valve disease) or CAD significant enough to cause global systolic impairment. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 Systolic dysfunction caused by DCM often presents as fatigue, angina or chronic heart failure. Autosomal dominant inheritance is believed to be the most common cause of DCM, occurring in approximately 20% to 35% of cases. ADDIN EN.CITE <EndNote><Cite><Author>Hershberger</Author><Year>2011</Year><RecNum>183</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>183</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413714300">183</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hershberger, R. E.</author><author>Siegfried, J. D.</author></authors></contributors><auth-address>Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, 1501 NW 10th Avenue, Miami, FL 33136, USA. rhershberger@med.miami.edu</auth-address><titles><title>Update 2011: clinical and genetic issues in familial dilated cardiomyopathy</title><secondary-title>J Am Coll Cardiol</secondary-title><alt-title>Journal of the American College of Cardiology</alt-title></titles><periodical><full-title>J Am Coll Cardiol</full-title></periodical><pages>1641-9</pages><volume>57</volume><number>16</number><edition>2011/04/16</edition><keywords><keyword>Animals</keyword><keyword>*Cardiomyopathy, Dilated/diagnosis/genetics</keyword><keyword>Genetic Testing/methods/trends</keyword><keyword>Genotype</keyword><keyword>High-Throughput Nucleotide Sequencing/methods/trends</keyword><keyword>Humans</keyword><keyword>Mutation/genetics</keyword><keyword>Phenotype</keyword></keywords><dates><year>2011</year><pub-dates><date>Apr 19</date></pub-dates></dates><isbn>0735-1097</isbn><accession-num>21492761</accession-num><urls></urls><custom2>Pmc3088091</custom2><custom6>Nihms288703</custom6><electronic-resource-num>10.1016/j.jacc.2011.01.015</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>18 Other causes include, but are not limited to, infection, inflammation (i.e. myocarditis), toxins and auto-immune disorders. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 The prevalence of DCM is currently unknown, although evidence from the United States estimates the disease to be prevalent in approximately one in every 2,500 individuals. ADDIN EN.CITE <EndNote><Cite><Author>Codd</Author><Year>1989</Year><RecNum>196</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>196</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1415332257">196</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Codd, M. B.</author><author>Sugrue, D. D.</author><author>Gersh, B. J.</author><author>Melton, L. J., 3rd</author></authors></contributors><auth-address>Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905.</auth-address><titles><title>Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. A population-based study in Olmsted County, Minnesota, 1975-1984</title><secondary-title>Circulation</secondary-title><alt-title>Circulation</alt-title></titles><periodical><full-title>Circulation</full-title></periodical><alt-periodical><full-title>Circulation</full-title></alt-periodical><pages>564-72</pages><volume>80</volume><number>3</number><edition>1989/09/01</edition><keywords><keyword>Age Factors</keyword><keyword>Cardiomyopathy, Dilated/diagnosis/*epidemiology/pathology</keyword><keyword>Cardiomyopathy, Hypertrophic/diagnosis/*epidemiology/pathology</keyword><keyword>Cardiomyopathy, Restrictive/diagnosis/epidemiology/pathology</keyword><keyword>Humans</keyword><keyword>Medical Record Linkage</keyword><keyword>Minnesota</keyword><keyword>Myocardium/pathology</keyword><keyword>Sex Factors</keyword></keywords><dates><year>1989</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0009-7322 (Print)
0009-7322</isbn><accession-num>2766509</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>19Hypertrophic cardiomyopathy (HCM): Traditional definitions of HCM differentiate thickening of the ventricle wall caused by myocyte hypertrophy from thickening caused by interstitial infiltration or intracellular accumulation of metabolic substrates observed in restrictive cardiomyopathies. In clinical practice, non-invasive imaging techniques and myocardial biopsy are often unable to accurately make this distinction, prompting a revision of the definition of HCM to simply: “Increased ventricular wall thickness or mass in the absence of loading conditions (hypertension, valve disease) sufficient to cause the observed abnormality”. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 The increase in wall thickness may cause left ventricular (LV) outflow obstruction, arrhythmias, vasovagal syncope or abnormal peripheral vascular response. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2004</Year><RecNum>182</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>182</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413522420">182</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>McKenna, W. J.</author></authors></contributors><auth-address>University College London, London, UK.</auth-address><titles><title>Hypertrophic cardiomyopathy</title><secondary-title>Lancet</secondary-title><alt-title>Lancet</alt-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet</abbr-1></periodical><alt-periodical><full-title>Lancet</full-title><abbr-1>Lancet</abbr-1></alt-periodical><pages>1881-91</pages><volume>363</volume><number>9424</number><edition>2004/06/09</edition><keywords><keyword>*Cardiomyopathy, Hypertrophic/diagnosis/etiology/therapy</keyword><keyword>Humans</keyword></keywords><dates><year>2004</year><pub-dates><date>Jun 5</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>15183628</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(04)16358-7</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>20 Patients with HCM often have few presenting symptoms. Thus, a diagnosis of HCM is often incidental. The most common presenting symptoms include shortness of breath (dyspnea) and chest pain on exertion, but a few patients may also present with syncope or pre-syncope. It is estimated that HCM has a prevalence of approximately one in 500 adults, and 0.5 in 100,000 children.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FbGxpb3R0PC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FbGxpb3R0PC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48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ADDIN EN.CITE.DATA 20, 21 HCM is the most common cause of sudden cardiac death in young people. ADDIN EN.CITE <EndNote><Cite><Author>Chan</Author><Year>2014</Year><RecNum>56</RecNum><DisplayText><style face="superscript">22</style></DisplayText><record><rec-number>56</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413497441">56</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chan, A. K.</author><author>Somarouthu, B.</author><author>Ghoshhajra, B.</author></authors></contributors><auth-address>From the Massachusetts General Hospital, Boston, MA.</auth-address><titles><title>Magnetic resonance imaging for hypertrophic cardiomyopathy update</title><secondary-title>Top Magn Reson Imaging</secondary-title><alt-title>Topics in magnetic resonance imaging : TMRI</alt-title></titles><periodical><full-title>Top Magn Reson Imaging</full-title><abbr-1>Topics in magnetic resonance imaging : TMRI</abbr-1></periodical><alt-periodical><full-title>Top Magn Reson Imaging</full-title><abbr-1>Topics in magnetic resonance imaging : TMRI</abbr-1></alt-periodical><pages>33-41</pages><volume>23</volume><number>1</number><edition>2014/02/11</edition><dates><year>2014</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0899-3459</isbn><accession-num>24509622</accession-num><urls></urls><electronic-resource-num>10.1097/rmr.0000000000000010</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>22Restrictive cardiomyopathy (RCM): Although restrictive ventricular abnormalities may have several causes, RCM can be broadly defined as “restrictive ventricular physiology in the presence of normal or reduced diastolic volumes (of one or both ventricles), normal or reduced systolic volumes, and normal ventricular wall thickness”. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 Impaired myocardial relaxation is a characteristic trait of RCM, leading to inadequate diastolic filling in one or both ventricles. Systolic function is often normal, or near normal. RCM may be inherited, idiopathic or due to a systemic disorder. Common subtypes of RCM include iron overload cardiomyopathy (hemochromatosis), sarcoidosis, amyloidosis, and endocardial disorders. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 Patients with RCM often present with heart failure symptoms, and will eventually need a heart transplant due to the limited availability of effective therapeutic interventions. The prevalence of RCM is currently unknown, but it is believed to be the least common subtype of cardiomyopathy. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17Arrhythmogenic right ventricular cardiomyopathy (ARVC): Also known as arrhythmogenic right ventricular dysplasia (ARVD), ARVC presents as “the progressive replacement of right ventricular myocardium with adipose and fibrous tissue”. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 Patients with ARVC are commonly asymptomatic, but may present with cardiac arrhythmias that can cause sudden cardiac death. Biventricular heart failure is a late-stage symptom caused by diffuse disease, and is therefore not typically a presenting symptom of ARVC.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS
ZWNOdW0+Mzk8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4y
Mzwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjM5PC9yZWMtbnVtYmVy
Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icjV6enY5OTluejJzZG5ldnp6enZm
ZDBpeDB2enR6ZmR4MHNyIiB0aW1lc3RhbXA9IjE0MTI4OTkyMzgiPjM5PC9rZXk+PC9mb3JlaWdu
LWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250
cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5NYXJjdXMsIEYuIEkuPC9hdXRob3I+PGF1dGhvcj5N
Y0tlbm5hLCBXLiBKLjwvYXV0aG9yPjxhdXRob3I+U2hlcnJpbGwsIEQuPC9hdXRob3I+PGF1dGhv
cj5CYXNzbywgQy48L2F1dGhvcj48YXV0aG9yPkJhdWNlLCBCLjwvYXV0aG9yPjxhdXRob3I+Qmx1
ZW1rZSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkNhbGtpbnMsIEguPC9hdXRob3I+PGF1dGhvcj5D
b3JyYWRvLCBELjwvYXV0aG9yPjxhdXRob3I+Q294LCBNLiBHLjwvYXV0aG9yPjxhdXRob3I+RGF1
YmVydCwgSi4gUC48L2F1dGhvcj48YXV0aG9yPkZvbnRhaW5lLCBHLjwvYXV0aG9yPjxhdXRob3I+
R2VhciwgSy48L2F1dGhvcj48YXV0aG9yPkhhdWVyLCBSLjwvYXV0aG9yPjxhdXRob3I+TmF2YSwg
QS48L2F1dGhvcj48YXV0aG9yPlBpY2FyZCwgTS4gSC48L2F1dGhvcj48YXV0aG9yPlByb3Rvbm90
YXJpb3MsIE4uPC9hdXRob3I+PGF1dGhvcj5TYWZmaXR6LCBKLiBFLjwvYXV0aG9yPjxhdXRob3I+
U2FuYm9ybiwgRC4gTS48L2F1dGhvcj48YXV0aG9yPlN0ZWluYmVyZywgSi4gUy48L2F1dGhvcj48
YXV0aG9yPlRhbmRyaSwgSC48L2F1dGhvcj48YXV0aG9yPlRoaWVuZSwgRy48L2F1dGhvcj48YXV0
aG9yPlRvd2JpbiwgSi4gQS48L2F1dGhvcj48YXV0aG9yPlRzYXRzb3BvdWxvdSwgQS48L2F1dGhv
cj48YXV0aG9yPldpY2h0ZXIsIFQuPC9hdXRob3I+PGF1dGhvcj5aYXJlYmEsIFcuPC9hdXRob3I+
PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+VW5pdmVyc2l0eSBvZiBBcml6
b25hLCBUdWNzb24sIEFaLCBVU0EuIGZtYXJjdXNAdS5hcml6b25hLmVkdTwvYXV0aC1hZGRyZXNz
Pjx0aXRsZXM+PHRpdGxlPkRpYWdub3NpcyBvZiBhcnJoeXRobW9nZW5pYyByaWdodCB2ZW50cmlj
dWxhciBjYXJkaW9teW9wYXRoeS9keXNwbGFzaWE6IHByb3Bvc2VkIG1vZGlmaWNhdGlvbiBvZiB0
aGUgVGFzayBGb3JjZSBDcml0ZXJpYTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5FdXIgSGVhcnQg
Sjwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+RXVyb3BlYW4gaGVhcnQgam91cm5hbDwvYWx0
LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkV1ciBIZWFydCBKPC9mdWxs
LXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+ODA2LTE0PC9wYWdlcz48dm9sdW1lPjMxPC92b2x1
bWU+PG51bWJlcj43PC9udW1iZXI+PGVkaXRpb24+MjAxMC8wMi8yMzwvZWRpdGlvbj48a2V5d29y
ZHM+PGtleXdvcmQ+QXJyaHl0aG1vZ2VuaWMgUmlnaHQgVmVudHJpY3VsYXIgRHlzcGxhc2lhLypk
aWFnbm9zaXMvZ2VuZXRpY3MvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5CaW9wc3k8L2tleXdv
cmQ+PGtleXdvcmQ+RWxlY3Ryb2NhcmRpb2dyYXBoeTwva2V5d29yZD48a2V5d29yZD5HZW5vdHlw
ZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFnbmV0aWMgUmVz
b25hbmNlIEFuZ2lvZ3JhcGh5L3N0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5NeW9jYXJkaXVt
L3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5QaGVub3R5cGU8L2tleXdvcmQ+PGtleXdvcmQ+
UHJhY3RpY2UgR3VpZGVsaW5lcyBhcyBUb3BpYzwva2V5d29yZD48a2V5d29yZD5TZW5zaXRpdml0
eSBhbmQgU3BlY2lmaWNpdHk8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMDwv
eWVhcj48cHViLWRhdGVzPjxkYXRlPkFwcjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2Ju
PjAxOTUtNjY4eDwvaXNibj48YWNjZXNzaW9uLW51bT4yMDE3MjkxMjwvYWNjZXNzaW9uLW51bT48
dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3BtYy9h
cnRpY2xlcy9QTUMyODQ4MzI2L3BkZi9laHEwMjUucGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91
cmxzPjxjdXN0b20yPlBtYzI4NDgzMjY8L2N1c3RvbTI+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt
PjEwLjEwOTMvZXVyaGVhcnRqL2VocTAyNTwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90
ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3Vh
Z2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 23 ARVC is a familial condition, with both autosomal dominant and autosomal recessive inheritance. Although the estimated prevalence of ARVC is low (1 in 5000), it is a common cause of sudden cardiac death in young athletes. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17Unclassified cardiomyopathies: There are two key subtypes of unclassified cardiomyopathies, including left ventricular non-compaction cardiomyopathy—a rare condition that shares similar diagnostic features as DCM—and takotsubo cardiomyopathy, also referred to as transient left ventricular apical ballooning syndrome. Takotsubo cardiomyopathy is defined as “transient regional systolic dysfunction involving the left ventricular apex and/or mid-ventricle in the absence of obstructive coronary disease on coronary angiography”. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17 Apical ballooning typically causes chest pain that mimics angina, often prompting an investigation into suspected CAD. Symptoms typically resolve spontaneously within two weeks of presentation if left untreated.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FaXRlbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FaXRlbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE.DATA 24 The cause of takotsubo cardiomyopathy is currently unclear, but it appears to demonstrate post-menopausal female predominance, and often follows an acute emotional or physical stress episode.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FaXRlbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl
Y051bT4xNzU8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4y
NDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjE3NTwvcmVjLW51bWJl
cj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InI1enp2OTk5bnoyc2RuZXZ6enp2
ZmQwaXgwdnp0emZkeDBzciIgdGltZXN0YW1wPSIxNDEzNTAzNTE4Ij4xNzU8L2tleT48L2ZvcmVp
Z24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNv
bnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkVpdGVsLCBJLjwvYXV0aG9yPjxhdXRob3I+dm9u
IEtub2JlbHNkb3JmZi1CcmVua2VuaG9mZiwgRi48L2F1dGhvcj48YXV0aG9yPkJlcm5oYXJkdCwg
UC48L2F1dGhvcj48YXV0aG9yPkNhcmJvbmUsIEkuPC9hdXRob3I+PGF1dGhvcj5NdWVsbGVybGVp
bGUsIEsuPC9hdXRob3I+PGF1dGhvcj5BbGRyb3ZhbmRpLCBBLjwvYXV0aG9yPjxhdXRob3I+RnJh
bmNvbmUsIE0uPC9hdXRob3I+PGF1dGhvcj5EZXNjaCwgUy48L2F1dGhvcj48YXV0aG9yPkd1dGJl
cmxldCwgTS48L2F1dGhvcj48YXV0aG9yPlN0cm9obSwgTy48L2F1dGhvcj48YXV0aG9yPlNjaHVs
ZXIsIEcuPC9hdXRob3I+PGF1dGhvcj5TY2h1bHotTWVuZ2VyLCBKLjwvYXV0aG9yPjxhdXRob3I+
VGhpZWxlLCBILjwvYXV0aG9yPjxhdXRob3I+RnJpZWRyaWNoLCBNLiBHLjwvYXV0aG9yPjwvYXV0
aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlVuaXZlcnNpdHkgb2YgTGVpcHppZy1I
ZWFydCBDZW50ZXIsIERlcGFydG1lbnQgb2YgSW50ZXJuYWwgTWVkaWNpbmUvQ2FyZGlvbG9neSwg
U3RydW1wZWxsc3RyYXNzZSAzOSwgMDQyODkgTGVpcHppZywgR2VybWFueS4gaW5nb2VpdGVsQGdt
eC5kZTwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNsaW5pY2FsIGNoYXJhY3RlcmlzdGlj
cyBhbmQgY2FyZGlvdmFzY3VsYXIgbWFnbmV0aWMgcmVzb25hbmNlIGZpbmRpbmdzIGluIHN0cmVz
cyAodGFrb3RzdWJvKSBjYXJkaW9teW9wYXRoeTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5KYW1h
PC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5KYW1hPC9hbHQtdGl0bGU+PC90aXRsZXM+PHBl
cmlvZGljYWw+PGZ1bGwtdGl0bGU+SmFtYTwvZnVsbC10aXRsZT48YWJici0xPkphbWE8L2FiYnIt
MT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkphbWE8L2Z1bGwtdGl0
bGU+PGFiYnItMT5KYW1hPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+Mjc3LTg2PC9w
YWdlcz48dm9sdW1lPjMwNjwvdm9sdW1lPjxudW1iZXI+MzwvbnVtYmVyPjxlZGl0aW9uPjIwMTEv
MDcvMjE8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3Jk
PkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZCwgODAgYW5kIG92ZXI8L2tleXdvcmQ+PGtleXdv
cmQ+RWRlbWEvZXRpb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3
b3JkPkZpYnJvc2lzL2V0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48
a2V5d29yZD4qTWFnbmV0aWMgUmVzb25hbmNlIEltYWdpbmc8L2tleXdvcmQ+PGtleXdvcmQ+TWFs
ZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5NeW9jYXJk
aXVtLypwYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+TmVjcm9zaXMvZXRpb2xvZ3k8L2tleXdv
cmQ+PGtleXdvcmQ+UHJvc3BlY3RpdmUgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5TdHJlc3Ms
IFBzeWNob2xvZ2ljYWw8L2tleXdvcmQ+PGtleXdvcmQ+KlN0cm9rZSBWb2x1bWU8L2tleXdvcmQ+
PGtleXdvcmQ+VGFrb3RzdWJvIENhcmRpb215b3BhdGh5L2NvbXBsaWNhdGlvbnMvKmRpYWdub3Np
cy9wYXRob2xvZ3k8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48
cHViLWRhdGVzPjxkYXRlPkp1bCAyMDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAw
OTgtNzQ4NDwvaXNibj48YWNjZXNzaW9uLW51bT4yMTc3MTk4ODwvYWNjZXNzaW9uLW51bT48dXJs
cz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL2phbWEuamFtYW5ldHdvcmsuY29tL2RhdGEvSm91
cm5hbHMvSkFNQS8yMjQ1OC9qb2MxNTA3NV8yNzdfMjg2LnBkZjwvdXJsPjwvcmVsYXRlZC11cmxz
PjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTAwMS9qYW1hLjIwMTEuOTkyPC9l
bGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVt
b3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwv
Q2l0ZT48L0VuZE5vdGU+
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FaXRlbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE.DATA 24 The exact prevalence of takotsubo cardiomyopathy is currently unknown, but it is estimated to occur in 2% of patients presenting with an acute coronary syndrome in the United States and Europe. ADDIN EN.CITE <EndNote><Cite><Author>Prasad</Author><Year>2008</Year><RecNum>184</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>184</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413724914">184</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prasad, A.</author><author>Lerman, A.</author><author>Rihal, C. S.</author></authors></contributors><auth-address>The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. prasad.abhiram@mayo.edu</auth-address><titles><title>Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction</title><secondary-title>Am Heart J</secondary-title><alt-title>American heart journal</alt-title></titles><periodical><full-title>Am Heart J</full-title><abbr-1>American heart journal</abbr-1></periodical><alt-periodical><full-title>Am Heart J</full-title><abbr-1>American heart journal</abbr-1></alt-periodical><pages>408-17</pages><volume>155</volume><number>3</number><edition>2008/02/26</edition><keywords><keyword>Biological Markers/blood</keyword><keyword>Coronary Angiography/*methods</keyword><keyword>Diagnosis, Differential</keyword><keyword>*Electrocardiography</keyword><keyword>Gated Blood-Pool Imaging/*methods</keyword><keyword>Humans</keyword><keyword>Myocardial Infarction/*diagnosis</keyword><keyword>Syndrome</keyword><keyword>Takotsubo Cardiomyopathy/blood/*diagnosis/physiopathology</keyword><keyword>Troponin T/*blood</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0002-8703</isbn><accession-num>18294473</accession-num><urls></urls><electronic-resource-num>10.1016/j.ahj.2007.11.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>25 It is estimated that between 4% and 7% of patients with a suspected acute coronary event will have had a myocardial infarct in the absence of significant coronary stenosis.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db2xsc3RlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db2xsc3RlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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==
ADDIN EN.CITE.DATA 26Incidence and prevalence of cardiomyopathies in AustraliaThe true prevalence of cardiomyopathies in Australia is unknown, as data for cardiomyopathies and heart failure are reported coincidentally. Estimates from the National Health Survey suggest that heart failure was prevalent in 1.3% of Australians in 2007-2008, with female gender predominance. ADDIN EN.CITE <EndNote><Cite><Author>AIHW</Author><Year>2011</Year><RecNum>5</RecNum><DisplayText><style face="superscript">27</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126321">5</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>AIHW</author></authors></contributors><titles><title>Cardiovascular disease: Australian facts 2011</title><secondary-title>Cardiovascular disease series</secondary-title></titles><number>Cat. no. CVD 53</number><dates><year>2011</year></dates><pub-location>Canberra</pub-location><publisher>Australian Institute of Health and Welfare</publisher><urls></urls></record></Cite></EndNote>27 By extrapolating from international findings, it has been estimated that heart failure presents in 30,000 new cases in Australia each year. In 2007-2008, heart failure or cardiomyopathy accounted for 10% of all hospitalisations for cardiovascular disease. ADDIN EN.CITE <EndNote><Cite><Author>AIHW</Author><Year>2011</Year><RecNum>5</RecNum><DisplayText><style face="superscript">27</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126321">5</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>AIHW</author></authors></contributors><titles><title>Cardiovascular disease: Australian facts 2011</title><secondary-title>Cardiovascular disease series</secondary-title></titles><number>Cat. no. CVD 53</number><dates><year>2011</year></dates><pub-location>Canberra</pub-location><publisher>Australian Institute of Health and Welfare</publisher><urls></urls></record></Cite></EndNote>27 Most patients who were hospitalised were aged 65 years and older, and nearly 90% of deaths occurred in adults over the age of 75. As discussed, some forms of cardiomyopathy, particularly ARVC and HCM, may cause cardiac arrhythmias prior to heart failure, resulting in sudden cardiac death. Estimates from the Australian Bureau of Statistics indicate that a total of 3,849 patients died from heart failure in 2012 (10th most common cause of death) and 1,720 died from cardiac arrhythmia (19th most common cause of death); ADDIN EN.CITE <EndNote><Cite><Author>ABS</Author><Year>2012</Year><RecNum>54</RecNum><DisplayText><style face="superscript">28</style></DisplayText><record><rec-number>54</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413431753">54</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>ABS</author></authors></contributors><titles><title>3303.0 - Causes of Death, Australia, 2012</title></titles><volume>2014</volume><number>16 October</number><dates><year>2012</year></dates><pub-location>Canberra</pub-location><publisher>Australian Bureau of Statistics</publisher><urls><related-urls><url> However, it is impossible to determine what proportion of heart failure or arrhythmia deaths were directly related to non-ischaemic cardiomyopathies.Australian Institute of Health and Welfare (AIHW) principal diagnosis data cubes indicate that there were 4,845 hospital separations for cardiomyopathies in 2011-12. ADDIN EN.CITE <EndNote><Cite><Author>Australian Insitute of Health and Welfare</Author><Year>2013</Year><RecNum>199</RecNum><DisplayText><style face="superscript">29</style></DisplayText><record><rec-number>199</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1415762889">199</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Australian Insitute of Health and Welfare,</author></authors></contributors><titles><title>Separation statistics by principal diagnosis in ICD-10-AM</title></titles><volume>2013</volume><number>20 June</number><dates><year>2013</year></dates><publisher>AIHW</publisher><urls><related-urls><url> A large proportion of reported separations were either unspecified (1,222 separations), or labelled “Other” (828 separations). Although the reported hospital diagnoses provide an estimate of the annual Australian incidence of each disease, they carry two key limitations: first, they do not reflect the number of individuals that were investigated for each disorder, and second, CMRI will not be necessary for every case of suspected cardiomyopathy as the diagnosis and aetiology may be clear from prior testing. A summary of the estimated prevalence for each subtype of cardiomyopathy is provided in REF _Ref403132530 \h \* MERGEFORMAT Table 1, although these estimates should be used with caution due to limitations in the epidemiological data and AIHW hospital statistics. Discussions with the Protocol Advisory Sub Committee (PASC) suggest the Australian hospital separations listed in Table 1 are likely to provide an upper estimate for the likely utilisation of CMRI for investigating DCM. Conversely, HCM is grossly underestimated by hospital data, as the majority of patients will be managed in outpatient clinics.Table SEQ Table \* ARABIC 1: Estimated prevalence of cardiomyopathy subtypes derived from peer-reviewed literature, and total number of reported Australian hospital separations by aetiologyIndicationEstimated prevalence from literatureEstimated Australian prevalenceAustralian hospital separations, 2011-12?DCM1 in 2,500 ADDIN EN.CITE <EndNote><Cite><Author>Codd</Author><Year>1989</Year><RecNum>196</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>196</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1415332257">196</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Codd, M. B.</author><author>Sugrue, D. D.</author><author>Gersh, B. J.</author><author>Melton, L. J., 3rd</author></authors></contributors><auth-address>Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905.</auth-address><titles><title>Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. A population-based study in Olmsted County, Minnesota, 1975-1984</title><secondary-title>Circulation</secondary-title><alt-title>Circulation</alt-title></titles><periodical><full-title>Circulation</full-title></periodical><alt-periodical><full-title>Circulation</full-title></alt-periodical><pages>564-72</pages><volume>80</volume><number>3</number><edition>1989/09/01</edition><keywords><keyword>Age Factors</keyword><keyword>Cardiomyopathy, Dilated/diagnosis/*epidemiology/pathology</keyword><keyword>Cardiomyopathy, Hypertrophic/diagnosis/*epidemiology/pathology</keyword><keyword>Cardiomyopathy, Restrictive/diagnosis/epidemiology/pathology</keyword><keyword>Humans</keyword><keyword>Medical Record Linkage</keyword><keyword>Minnesota</keyword><keyword>Myocardium/pathology</keyword><keyword>Sex Factors</keyword></keywords><dates><year>1989</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0009-7322 (Print)
0009-7322</isbn><accession-num>2766509</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>197,160*2,066HCM1 in 500PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJzaDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJzaDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE.DATA 20, 2135,804*506RCMUnknown ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17**Unknown25ARVC1 in 5,000 ADDIN EN.CITE <EndNote><Cite><Author>Romero</Author><Year>2013</Year><RecNum>30</RecNum><DisplayText><style face="superscript">30</style></DisplayText><record><rec-number>30</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412896130">30</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Romero, J.</author><author>Mejia-Lopez, E.</author><author>Manrique, C.</author><author>Lucariello, R.</author></authors></contributors><auth-address>Division of Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.</auth-address><titles><title>Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC/D): A Systematic Literature Review</title><secondary-title>Clin Med Insights Cardiol</secondary-title><alt-title>Clin Med Insights Cardiol</alt-title></titles><periodical><full-title>Clin Med Insights Cardiol</full-title><abbr-1>Clinical Medicine Insights. Cardiology</abbr-1></periodical><alt-periodical><full-title>Clin Med Insights Cardiol</full-title><abbr-1>Clinical Medicine Insights. Cardiology</abbr-1></alt-periodical><pages>97-114</pages><volume>7</volume><edition>2013/06/14</edition><keywords><keyword>Arrhythmogenic right ventricular cardiomyopathy (ARVC/D)</keyword><keyword>cardiomyopathy</keyword><keyword>sudden cardiac death</keyword><keyword>tachyarrhythmias</keyword></keywords><dates><year>2013</year></dates><accession-num>23761986</accession-num><urls><related-urls><url>*Not reportedTakotsubo cardiomyopathy2% of ACS patients ADDIN EN.CITE <EndNote><Cite><Author>Prasad</Author><Year>2008</Year><RecNum>184</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>184</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413724914">184</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prasad, A.</author><author>Lerman, A.</author><author>Rihal, C. S.</author></authors></contributors><auth-address>The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. prasad.abhiram@mayo.edu</auth-address><titles><title>Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction</title><secondary-title>Am Heart J</secondary-title><alt-title>American heart journal</alt-title></titles><periodical><full-title>Am Heart J</full-title><abbr-1>American heart journal</abbr-1></periodical><alt-periodical><full-title>Am Heart J</full-title><abbr-1>American heart journal</abbr-1></alt-periodical><pages>408-17</pages><volume>155</volume><number>3</number><edition>2008/02/26</edition><keywords><keyword>Biological Markers/blood</keyword><keyword>Coronary Angiography/*methods</keyword><keyword>Diagnosis, Differential</keyword><keyword>*Electrocardiography</keyword><keyword>Gated Blood-Pool Imaging/*methods</keyword><keyword>Humans</keyword><keyword>Myocardial Infarction/*diagnosis</keyword><keyword>Syndrome</keyword><keyword>Takotsubo Cardiomyopathy/blood/*diagnosis/physiopathology</keyword><keyword>Troponin T/*blood</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0002-8703</isbn><accession-num>18294473</accession-num><urls></urls><electronic-resource-num>10.1016/j.ahj.2007.11.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>251,398??Not reportedAcute myocarditisUnknownUnknown213ACS=acute coronary syndrome, ARVC=Arrhythmogenic right ventricular cardiomyopathy, DCM= dilated cardiomyopathy, HCM=hypertrophic cardiomyopathy, RCM=restrictive cardiomyopathy.*Prevalence estimates are based on the Australian population aged 18 and older as of 30 June 2012, reported to be 17,902,257 in total. ADDIN EN.CITE <EndNote><Cite><Author>ABS</Author><Year>2013</Year><RecNum>198</RecNum><DisplayText><style face="superscript">31</style></DisplayText><record><rec-number>198</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1415336700">198</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>ABS</author></authors></contributors><titles><title>3101.0 - Australian Demographic Statistics, Mar 2013</title></titles><volume>2014</volume><number>November 7</number><dates><year>2013</year></dates><pub-location>Canberra, Australia</pub-location><publisher>Australian Bureau of Statistics</publisher><urls><related-urls><url>**While the prevalence of restrictive cardiomyopathy is unknown, it is estimated to be the least common subtype of cardiomyopathy. ADDIN EN.CITE <EndNote><Cite><Author>Elliott</Author><Year>2008</Year><RecNum>41</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>41</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413153278">41</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elliott, P.</author><author>Andersson, B.</author><author>Arbustini, E.</author><author>Bilinska, Z.</author><author>Cecchi, F.</author><author>Charron, P.</author><author>Dubourg, O.</author><author>Kuhl, U.</author><author>Maisch, B.</author><author>McKenna, W. J.</author><author>Monserrat, L.</author><author>Pankuweit, S.</author><author>Rapezzi, C.</author><author>Seferovic, P.</author><author>Tavazzi, L.</author><author>Keren, A.</author></authors></contributors><auth-address>Hadassah University Hospital Ein Kerem, Kirjat Hadassah, Jerusalem 91120, Israel.</auth-address><titles><title>Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>Eur Heart J</full-title></periodical><pages>270-6</pages><volume>29</volume><number>2</number><edition>2007/10/06</edition><keywords><keyword>Cardiomyopathies/*classification/*diagnosis</keyword><keyword>Europe</keyword><keyword>Humans</keyword><keyword>Societies, Medical</keyword><keyword>Ventricular Dysfunction/*classification</keyword></keywords><dates><year>2008</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0195-668X (Print)
0195-668x</isbn><accession-num>17916581</accession-num><urls></urls><electronic-resource-num>10.1093/eurheartj/ehm342</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>17?Data sourced from the Australian Institute of Health and Welfare’s principal diagnosis data cubes, 2011-12. ADDIN EN.CITE <EndNote><Cite><Author>Australian Insitute of Health and Welfare</Author><Year>2013</Year><RecNum>199</RecNum><DisplayText><style face="superscript">29</style></DisplayText><record><rec-number>199</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1415762889">199</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Australian Insitute of Health and Welfare,</author></authors></contributors><titles><title>Separation statistics by principal diagnosis in ICD-10-AM</title></titles><volume>2013</volume><number>20 June</number><dates><year>2013</year></dates><publisher>AIHW</publisher><urls><related-urls><url> based on 69,900 heart attack events in Australians over the age of 25 in 2011. ADDIN EN.CITE <EndNote><Cite><Author>AIHW</Author><Year>2014</Year><RecNum>210</RecNum><DisplayText><style face="superscript">32</style></DisplayText><record><rec-number>210</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1419295673">210</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>AIHW</author></authors></contributors><titles><title>Australia’s health 2014</title><secondary-title>Australia’s health series no. 14</secondary-title></titles><volume>Cat. no. AUS 178</volume><dates><year>2014</year></dates><pub-location>Canberra</pub-location><publisher>Australian Institute of Health and Welfare,</publisher><urls></urls></record></Cite></EndNote>32Define the proposed patient population that would benefit from the use of this service. This could include issues such as patient characteristics and /or specific circumstances that patients would have to satisfy in order to access the service. Cardiomyopathies are a disparate group; however, the clinical presentations of these patients are broadly similar. There is also considerable phenotypic overlap between the different types of cardiomyopathy. The Applicant has suggested that five cardiomyopathy sub-populations will benefit from the use of CMRI. Through consultation with the PASC, populations one to three include an additional subgroup of asymptomatic first-degree relatives. The proposed patient populations include:Patients presenting with heart failure symptoms, in whom echocardiography is inconclusive or suggests a dilated cardiomyopathy, and in whom further diagnostic clarification is required.Asymptomatic individuals with a family history of non-ischaemic dilated cardiomyopathy in a first-degree relative.Patients in whom echocardiography suggests increased wall thickness, and in whom a hypertrophic or restrictive cardiomyopathy is suspected and further diagnostic clarification is required.Asymptomatic individuals with a family history of hypertrophic or restrictive cardiomyopathy in a first-degree relative.Patients in whom arrhythmogenic right ventricular cardiomyopathy is suspected on the basis of International Task Force Criteria.Asymptomatic individuals with a family history of arrhythmogenic right ventricular cardiomyopathy in a first-degree relative.Patients with troponin-positive chest pain, electrocardiography changes suspicious of an acute coronary syndrome, and no culprit lesion identified on coronary angiography.Asymptomatic individuals with a family history of sudden cardiac death or aborted sudden cardiac death in a first-degree relative, excluding channelopathies and arrhythmia.Indicate if there is evidence for the population who would benefit from this service i.e. international evidence including inclusion / exclusion criteria. If appropriate provide a table summarising the population considered in the evidence.At least two systematic reviews have investigated the use of CMRI for the investigation of patients with suspected non-ischaemic cardiomyopathies, e.g. Kuruvilla et al (2014),PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdXJ1dmlsbGE8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy
PjxSZWNOdW0+Mjg8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0
Ij4zMzwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjI4PC9yZWMtbnVt
YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icjV6enY5OTluejJzZG5ldnp6
enZmZDBpeDB2enR6ZmR4MHNyIiB0aW1lc3RhbXA9IjE0MTI4OTU5OTYiPjI4PC9rZXk+PC9mb3Jl
aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj
b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LdXJ1dmlsbGEsIFMuPC9hdXRob3I+PGF1dGhv
cj5BZGVuYXcsIE4uPC9hdXRob3I+PGF1dGhvcj5LYXR3YWwsIEEuIEIuPC9hdXRob3I+PGF1dGhv
cj5MaXBpbnNraSwgTS4gSi48L2F1dGhvcj48YXV0aG9yPktyYW1lciwgQy4gTS48L2F1dGhvcj48
YXV0aG9yPlNhbGVybm8sIE0uPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRo
LWFkZHJlc3M+RGl2aXNpb24gb2YgQ2FyZGlvbG9neSwgRGVwYXJ0bWVudCBvZiBNZWRpY2luZSws
IERlcGFydG1lbnQgb2YgUmFkaW9sb2d5IGFuZCBNZWRpY2FsIEltYWdpbmcsIGFuZCBEZXBhcnRt
ZW50IG9mIEJpb21lZGljYWwgRW5naW5lZXJpbmcsIFVuaXZlcnNpdHkgb2YgVmlyZ2luaWEgSGVh
bHRoIFN5c3RlbSwgQ2hhcmxvdHRlc3ZpbGxlLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxl
PkxhdGUgZ2Fkb2xpbml1bSBlbmhhbmNlbWVudCBvbiBjYXJkaWFjIG1hZ25ldGljIHJlc29uYW5j
ZSBwcmVkaWN0cyBhZHZlcnNlIGNhcmRpb3Zhc2N1bGFyIG91dGNvbWVzIGluIG5vbmlzY2hlbWlj
IGNhcmRpb215b3BhdGh5OiBhIHN5c3RlbWF0aWMgcmV2aWV3IGFuZCBtZXRhLWFuYWx5c2lzPC90
aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkNpcmMgQ2FyZGlvdmFzYyBJbWFnaW5nPC9zZWNvbmRhcnkt
dGl0bGU+PGFsdC10aXRsZT5DaXJjIENhcmRpb3Zhc2MgSW1hZ2luZzwvYWx0LXRpdGxlPjwvdGl0
bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNpcmMgQ2FyZGlvdmFzYyBJbWFnaW5nPC9mdWxs
LXRpdGxlPjxhYmJyLTE+Q2lyY3VsYXRpb24uIENhcmRpb3Zhc2N1bGFyIGltYWdpbmc8L2FiYnIt
MT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNpcmMgQ2FyZGlvdmFz
YyBJbWFnaW5nPC9mdWxsLXRpdGxlPjxhYmJyLTE+Q2lyY3VsYXRpb24uIENhcmRpb3Zhc2N1bGFy
IGltYWdpbmc8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4yNTAtODwvcGFnZXM+PHZv
bHVtZT43PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxMy8xMi8yNDwvZWRp
dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+KkNhcmRpb215b3BhdGhpZXMvY29tcGxpY2F0aW9ucy9k
aWFnbm9zaXMvcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkNvbnRyYXN0IE1lZGlh
L2RpYWdub3N0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkRlYXRoLCBTdWRkZW4sIENhcmRpYWMv
ZXBpZGVtaW9sb2d5LypwcmV2ZW50aW9uICZhbXA7IGNvbnRyb2w8L2tleXdvcmQ+PGtleXdvcmQ+
KkRlbGF5ZWQgRGlhZ25vc2lzPC9rZXl3b3JkPjxrZXl3b3JkPkdhZG9saW5pdW0gRFRQQS8qZGlh
Z25vc3RpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+SGVhcnQgRmFpbHVyZS8qZGlhZ25vc2lzL2Vw
aWRlbWlvbG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SW5j
aWRlbmNlPC9rZXl3b3JkPjxrZXl3b3JkPk1hZ25ldGljIFJlc29uYW5jZSBJbWFnaW5nLCBDaW5l
LyptZXRob2RzPC9rZXl3b3JkPjxrZXl3b3JkPk15b2NhcmRpdW0vcGF0aG9sb2d5PC9rZXl3b3Jk
PjxrZXl3b3JkPlByZWRpY3RpdmUgVmFsdWUgb2YgVGVzdHM8L2tleXdvcmQ+PGtleXdvcmQ+UHJv
Z25vc2lzPC9rZXl3b3JkPjxrZXl3b3JkPlJpc2sgRmFjdG9yczwva2V5d29yZD48a2V5d29yZD5T
dXJ2aXZhbCBSYXRlL3RyZW5kczwva2V5d29yZD48a2V5d29yZD5UaW1lIEZhY3RvcnM8L2tleXdv
cmQ+PGtleXdvcmQ+VmVudHJpY3VsYXIgRnVuY3Rpb24sIExlZnQ8L2tleXdvcmQ+PGtleXdvcmQ+
V29ybGQgSGVhbHRoPC9rZXl3b3JkPjxrZXl3b3JkPmNhcmRpYWMgbWFnbmV0aWMgcmVzb25hbmNl
IGltYWdpbmc8L2tleXdvcmQ+PGtleXdvcmQ+bGF0ZSBnYWRvbGluaXVtIGVuaGFuY2VtZW50PC9r
ZXl3b3JkPjxrZXl3b3JkPm5vbmlzY2hlbWljIGNhcmRpb21pb3BhdGh5PC9rZXl3b3JkPjwva2V5
d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTQ8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXI8L2RhdGU+
PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xOTQxLTk2NTE8L2lzYm4+PGFjY2Vzc2lvbi1udW0+
MjQzNjMzNTg8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBtYzQwMDc1ODM8
L2N1c3RvbTI+PGN1c3RvbTY+TmlobXM1NTkzNDA8L2N1c3RvbTY+PGVsZWN0cm9uaWMtcmVzb3Vy
Y2UtbnVtPjEwLjExNjEvY2lyY2ltYWdpbmcuMTEzLjAwMTE0NDwvZWxlY3Ryb25pYy1yZXNvdXJj
ZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92
aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdXJ1dmlsbGE8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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==
ADDIN EN.CITE.DATA 33 Green et al (2012). ADDIN EN.CITE <EndNote><Cite><Author>Green</Author><Year>2012</Year><RecNum>10</RecNum><DisplayText><style face="superscript">34</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126464">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Green, J. J.</author><author>Berger, J. S.</author><author>Kramer, C. M.</author><author>Salerno, M.</author></authors></contributors><auth-address>Department of Medicine, Cardiology Division, University of Virginia, Charlottesville, Virginia 22908, USA.</auth-address><titles><title>Prognostic value of late gadolinium enhancement in clinical outcomes for hypertrophic cardiomyopathy</title><secondary-title>JACC Cardiovasc Imaging</secondary-title></titles><periodical><full-title>JACC Cardiovasc Imaging</full-title></periodical><pages>370-7</pages><volume>5</volume><number>4</number><edition>2012/04/14</edition><keywords><keyword>Cardiomyopathy, Hypertrophic/ diagnosis/mortality</keyword><keyword>Contrast Media/ diagnostic use</keyword><keyword>Death, Sudden, Cardiac/ epidemiology/etiology</keyword><keyword>Delayed Diagnosis</keyword><keyword>Fibrosis/diagnosis</keyword><keyword>Gadolinium/ diagnostic use</keyword><keyword>Humans</keyword><keyword>Image Enhancement</keyword><keyword>Magnetic Resonance Imaging, Cine/ methods</keyword><keyword>Myocardium/ pathology</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword><keyword>Survival Rate/trends</keyword><keyword>World Health</keyword></keywords><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1876-7591 (Electronic)</isbn><accession-num>22498326</accession-num><urls><related-urls><url> Similarly, a number of narrative reviews exist outlining the clinical efficacy of CMRI for various subtypes of cardiomyopathy e.g. Leong et al (2012),PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZW9uZzwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZW9uZzwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA 35 To et al (2011), ADDIN EN.CITE <EndNote><Cite><Author>To</Author><Year>2011</Year><RecNum>206</RecNum><DisplayText><style face="superscript">36</style></DisplayText><record><rec-number>206</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1418167547">206</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>To, A. C.</author><author>Dhillon, A.</author><author>Desai, M. Y.</author></authors></contributors><auth-address>Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.</auth-address><titles><title>Cardiac magnetic resonance in hypertrophic cardiomyopathy</title><secondary-title>JACC Cardiovasc Imaging</secondary-title><alt-title>JACC. Cardiovascular imaging</alt-title></titles><periodical><full-title>JACC Cardiovasc Imaging</full-title></periodical><pages>1123-37</pages><volume>4</volume><number>10</number><edition>2011/10/18</edition><keywords><keyword>Cardiomyopathy, Hypertrophic/*diagnosis/genetics/pathology/therapy</keyword><keyword>Diagnosis, Differential</keyword><keyword>Genetic Predisposition to Disease</keyword><keyword>Humans</keyword><keyword>*Magnetic Resonance Imaging</keyword><keyword>Myocardium/*pathology</keyword><keyword>Phenotype</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prognosis</keyword></keywords><dates><year>2011</year><pub-dates><date>Oct</date></pub-dates></dates><accession-num>21999873</accession-num><urls></urls><electronic-resource-num>10.1016/j.jcmg.2011.06.022</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>36 Srinivasan et al (2013), ADDIN EN.CITE <EndNote><Cite><Author>Srinivasan</Author><Year>2013</Year><RecNum>209</RecNum><DisplayText><style face="superscript">37</style></DisplayText><record><rec-number>209</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1418168049">209</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Srinivasan, G.</author><author>Joseph, M.</author><author>Selvanayagam, J. B.</author></authors></contributors><auth-address>Department of Medicine, Flinders University, Flinders Medical Centre, Adelaide 5042, Australia.</auth-address><titles><title>Recent advances in the imaging assessment of infiltrative cardiomyopathies</title><secondary-title>Heart</secondary-title><alt-title>Heart (British Cardiac Society)</alt-title></titles><periodical><full-title>Heart</full-title><abbr-1>Heart (British Cardiac Society)</abbr-1></periodical><alt-periodical><full-title>Heart</full-title><abbr-1>Heart (British Cardiac Society)</abbr-1></alt-periodical><pages>204-13</pages><volume>99</volume><number>3</number><edition>2013/01/01</edition><keywords><keyword>Cardiomyopathies/*diagnosis</keyword><keyword>Diagnosis, Differential</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging, Cine/*methods</keyword><keyword>Myocardium/*pathology</keyword><keyword>Reproducibility of Results</keyword></keywords><dates><year>2013</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1355-6037</isbn><accession-num>23274921</accession-num><urls></urls><electronic-resource-num>10.1136/heartjnl-2012-301793</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>37 Dickerson et al (2013).PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EaWNrZXJzb248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EaWNrZXJzb248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy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=
ADDIN EN.CITE.DATA 38 There is evidence that CMRI is a cost effective and clinically effective intervention for patients presenting with heart failure. Assomull et al (2011) demonstrated that using CMRI as a gatekeeper to invasive coronary angiography (ICA) was a cheaper diagnostic strategy in a decision tree model when United Kingdom–based costs were assumed. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA 39 For CMRI the sensitivity (100%), specificity (96%), and diagnostic accuracy (97%) were equivalent to ICA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). Hence CMRI proved to be a safe, clinically effective, and potentially economical gatekeeper to ICA in patients presenting with heart failure of uncertain aetiology. CMRI has proven cost effectiveness for the diagnosis of CAD and this may be relevant for patients presenting with ischaemic heart failure. Relevant recent papers include Walker et al (2013)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XYWxrZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
ZWNOdW0+MjE0PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+
NDA8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMTQ8L3JlYy1udW1i
ZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJyNXp6djk5OW56MnNkbmV2enp6
dmZkMGl4MHZ6dHpmZHgwc3IiIHRpbWVzdGFtcD0iMTQyNDIyODczMCI+MjE0PC9rZXk+PC9mb3Jl
aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj
b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5XYWxrZXIsIFMuPC9hdXRob3I+PGF1dGhvcj5H
aXJhcmRpbiwgRi48L2F1dGhvcj48YXV0aG9yPk1jS2VubmEsIEMuPC9hdXRob3I+PGF1dGhvcj5C
YWxsLCBTLiBHLjwvYXV0aG9yPjxhdXRob3I+Tml4b24sIEouPC9hdXRob3I+PGF1dGhvcj5QbGVp
biwgUy48L2F1dGhvcj48YXV0aG9yPkdyZWVud29vZCwgSi4gUC48L2F1dGhvcj48YXV0aG9yPlNj
dWxwaGVyLCBNLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNz
PkNlbnRyZSBmb3IgSGVhbHRoIEVjb25vbWljcywgVW5pdmVyc2l0eSBvZiBZb3JrLCBBbGN1aW4g
QSBCbG9jaywgSGVzbGluZ3RvbiwgWW9yayBZTzEwIDVERCwgVUsuIHNpbW9uLndhbGtlckB5b3Jr
LmFjLnVrPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+Q29zdC1lZmZlY3RpdmVuZXNzIG9m
IGNhcmRpb3Zhc2N1bGFyIG1hZ25ldGljIHJlc29uYW5jZSBpbiB0aGUgZGlhZ25vc2lzIG9mIGNv
cm9uYXJ5IGhlYXJ0IGRpc2Vhc2U6IGFuIGVjb25vbWljIGV2YWx1YXRpb24gdXNpbmcgZGF0YSBm
cm9tIHRoZSBDRS1NQVJDIHN0dWR5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkhlYXJ0PC9zZWNv
bmRhcnktdGl0bGU+PGFsdC10aXRsZT5IZWFydCAoQnJpdGlzaCBDYXJkaWFjIFNvY2lldHkpPC9h
bHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SGVhcnQ8L2Z1bGwtdGl0
bGU+PGFiYnItMT5IZWFydCAoQnJpdGlzaCBDYXJkaWFjIFNvY2lldHkpPC9hYmJyLTE+PC9wZXJp
b2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5IZWFydDwvZnVsbC10aXRsZT48YWJi
ci0xPkhlYXJ0IChCcml0aXNoIENhcmRpYWMgU29jaWV0eSk8L2FiYnItMT48L2FsdC1wZXJpb2Rp
Y2FsPjxwYWdlcz44NzMtODE8L3BhZ2VzPjx2b2x1bWU+OTk8L3ZvbHVtZT48bnVtYmVyPjEyPC9u
dW1iZXI+PGVkaXRpb24+MjAxMy8wNC8xODwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+Q29y
b25hcnkgRGlzZWFzZS8qZGlhZ25vc2lzL2Vjb25vbWljczwva2V5d29yZD48a2V5d29yZD5Db3N0
LUJlbmVmaXQgQW5hbHlzaXM8L2tleXdvcmQ+PGtleXdvcmQ+KkRlY2lzaW9uIFN1cHBvcnQgVGVj
aG5pcXVlczwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R3JlYXQg
QnJpdGFpbjwva2V5d29yZD48a2V5d29yZD5Ib3NwaXRhbCBDb3N0cy8qdHJlbmRzPC9rZXl3b3Jk
PjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWduZXRpYyBSZXNvbmFuY2UgSW1h
Z2luZywgQ2luZS8qZWNvbm9taWNzPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtl
eXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Kk1vZGVscywgRWNvbm9taWM8L2tl
eXdvcmQ+PGtleXdvcmQ+SW1hZ2luZyBBbmQgRGlhZ25vc3RpY3M8L2tleXdvcmQ+PC9rZXl3b3Jk
cz48ZGF0ZXM+PHllYXI+MjAxMzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48L3B1
Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTUtNjAzNzwvaXNibj48YWNjZXNzaW9uLW51bT4yMzU5
MTY2ODwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt
PjEwLjExMzYvaGVhcnRqbmwtMjAxMy0zMDM2MjQ8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxy
ZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxh
bmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XYWxrZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
ZWNOdW0+MjE0PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+
NDA8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMTQ8L3JlYy1udW1i
ZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJyNXp6djk5OW56MnNkbmV2enp6
dmZkMGl4MHZ6dHpmZHgwc3IiIHRpbWVzdGFtcD0iMTQyNDIyODczMCI+MjE0PC9rZXk+PC9mb3Jl
aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj
b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5XYWxrZXIsIFMuPC9hdXRob3I+PGF1dGhvcj5H
aXJhcmRpbiwgRi48L2F1dGhvcj48YXV0aG9yPk1jS2VubmEsIEMuPC9hdXRob3I+PGF1dGhvcj5C
YWxsLCBTLiBHLjwvYXV0aG9yPjxhdXRob3I+Tml4b24sIEouPC9hdXRob3I+PGF1dGhvcj5QbGVp
biwgUy48L2F1dGhvcj48YXV0aG9yPkdyZWVud29vZCwgSi4gUC48L2F1dGhvcj48YXV0aG9yPlNj
dWxwaGVyLCBNLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNz
PkNlbnRyZSBmb3IgSGVhbHRoIEVjb25vbWljcywgVW5pdmVyc2l0eSBvZiBZb3JrLCBBbGN1aW4g
QSBCbG9jaywgSGVzbGluZ3RvbiwgWW9yayBZTzEwIDVERCwgVUsuIHNpbW9uLndhbGtlckB5b3Jr
LmFjLnVrPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+Q29zdC1lZmZlY3RpdmVuZXNzIG9m
IGNhcmRpb3Zhc2N1bGFyIG1hZ25ldGljIHJlc29uYW5jZSBpbiB0aGUgZGlhZ25vc2lzIG9mIGNv
cm9uYXJ5IGhlYXJ0IGRpc2Vhc2U6IGFuIGVjb25vbWljIGV2YWx1YXRpb24gdXNpbmcgZGF0YSBm
cm9tIHRoZSBDRS1NQVJDIHN0dWR5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkhlYXJ0PC9zZWNv
bmRhcnktdGl0bGU+PGFsdC10aXRsZT5IZWFydCAoQnJpdGlzaCBDYXJkaWFjIFNvY2lldHkpPC9h
bHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SGVhcnQ8L2Z1bGwtdGl0
bGU+PGFiYnItMT5IZWFydCAoQnJpdGlzaCBDYXJkaWFjIFNvY2lldHkpPC9hYmJyLTE+PC9wZXJp
b2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5IZWFydDwvZnVsbC10aXRsZT48YWJi
ci0xPkhlYXJ0IChCcml0aXNoIENhcmRpYWMgU29jaWV0eSk8L2FiYnItMT48L2FsdC1wZXJpb2Rp
Y2FsPjxwYWdlcz44NzMtODE8L3BhZ2VzPjx2b2x1bWU+OTk8L3ZvbHVtZT48bnVtYmVyPjEyPC9u
dW1iZXI+PGVkaXRpb24+MjAxMy8wNC8xODwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+Q29y
b25hcnkgRGlzZWFzZS8qZGlhZ25vc2lzL2Vjb25vbWljczwva2V5d29yZD48a2V5d29yZD5Db3N0
LUJlbmVmaXQgQW5hbHlzaXM8L2tleXdvcmQ+PGtleXdvcmQ+KkRlY2lzaW9uIFN1cHBvcnQgVGVj
aG5pcXVlczwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R3JlYXQg
QnJpdGFpbjwva2V5d29yZD48a2V5d29yZD5Ib3NwaXRhbCBDb3N0cy8qdHJlbmRzPC9rZXl3b3Jk
PjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWduZXRpYyBSZXNvbmFuY2UgSW1h
Z2luZywgQ2luZS8qZWNvbm9taWNzPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtl
eXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Kk1vZGVscywgRWNvbm9taWM8L2tl
eXdvcmQ+PGtleXdvcmQ+SW1hZ2luZyBBbmQgRGlhZ25vc3RpY3M8L2tleXdvcmQ+PC9rZXl3b3Jk
cz48ZGF0ZXM+PHllYXI+MjAxMzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48L3B1
Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTUtNjAzNzwvaXNibj48YWNjZXNzaW9uLW51bT4yMzU5
MTY2ODwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt
PjEwLjExMzYvaGVhcnRqbmwtMjAxMy0zMDM2MjQ8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxy
ZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxh
bmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=
ADDIN EN.CITE.DATA 40 and Boldt et al (2013). ADDIN EN.CITE <EndNote><Cite><Author>Boldt</Author><Year>2013</Year><RecNum>215</RecNum><DisplayText><style face="superscript">41</style></DisplayText><record><rec-number>215</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1424228777">215</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Boldt, J.</author><author>Leber, A. W.</author><author>Bonaventura, K.</author><author>Sohns, C.</author><author>Stula, M.</author><author>Huppertz, A.</author><author>Haverkamp, W.</author><author>Dorenkamp, M.</author></authors></contributors><auth-address>Department of Cardiology, Charite - Universitatsmedizin Berlin, Campus Virchow-Klinikum Augustenburger Platz 1, Berlin 13353, Germany.</auth-address><titles><title>Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany</title><secondary-title>J Cardiovasc Magn Reson</secondary-title><alt-title>Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance</alt-title></titles><periodical><full-title>J Cardiovasc Magn Reson</full-title></periodical><pages>30</pages><volume>15</volume><edition>2013/04/12</edition><keywords><keyword>Bayes Theorem</keyword><keyword>Coronary Angiography</keyword><keyword>Coronary Artery Disease/*diagnosis/*economics</keyword><keyword>Cost-Benefit Analysis</keyword><keyword>Germany</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging/*economics</keyword><keyword>Quality-Adjusted Life Years</keyword><keyword>Tomography, Emission-Computed, Single-Photon/*economics</keyword></keywords><dates><year>2013</year></dates><isbn>1097-6647</isbn><accession-num>23574690</accession-num><urls></urls><custom2>Pmc3688498</custom2><electronic-resource-num>10.1186/1532-429x-15-30</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>41The European CMR registry is a pivotal, multi-national study with over 27,000 enrolled patients from 57 centres in 15 countries.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 1 The study included patients with DCM (population 1), HCM (population 2) and ARVC (population 3). The authors reported a demonstrated impact of CMRI on patient management in 62% of cases, including a new diagnosis not suspected before the CMRI in 9% of cases, and a change in therapeutic management in 53% of cases. Additional studies reporting surrogate outcomes of effectiveness of CMRI in each population are outlined below:Dilated CardiomyopathyChange in Management: McCrohon et al (2003) investigated the use of CMRI in 90 patients with heart failure due to DCM. The findings suggest that using coronary angiography as the arbiter for the presence of LV dysfunction caused by CAD, may lead to an incorrect assignment of the cause of DCM in 13% of patients.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY0Nyb2hvbjwvQXV0aG9yPjxZZWFyPjIwMDM8L1llYXI+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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY0Nyb2hvbjwvQXV0aG9yPjxZZWFyPjIwMDM8L1llYXI+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=
ADDIN EN.CITE.DATA 42Cost effectiveness / diagnostic accuracy: Assomull et al (2011) assessed the diagnostic accuracy of CMRI as a non-invasive gatekeeper to coronary angiography in 120 consecutive patients with heart failure of unknown aetiology.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+
PFJlY051bT4zPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+
Mzk8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4zPC9yZWMtbnVtYmVy
Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icjV6enY5OTluejJzZG5ldnp6enZm
ZDBpeDB2enR6ZmR4MHNyIiB0aW1lc3RhbXA9IjE0MTIxMjYzMTAiPjM8L2tleT48L2ZvcmVpZ24t
a2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRy
aWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkFzc29tdWxsLCBSLiBHLjwvYXV0aG9yPjxhdXRob3I+
U2hha2VzcGVhcmUsIEMuPC9hdXRob3I+PGF1dGhvcj5LYWxyYSwgUC4gUi48L2F1dGhvcj48YXV0
aG9yPkxsb3lkLCBHLjwvYXV0aG9yPjxhdXRob3I+R3VsYXRpLCBBLjwvYXV0aG9yPjxhdXRob3I+
U3RyYW5nZSwgSi48L2F1dGhvcj48YXV0aG9yPkJyYWRsb3csIFcuIE0uPC9hdXRob3I+PGF1dGhv
cj5MeW5lLCBKLjwvYXV0aG9yPjxhdXRob3I+S2VlZ2FuLCBKLjwvYXV0aG9yPjxhdXRob3I+UG9v
bGUtV2lsc29uLCBQLjwvYXV0aG9yPjxhdXRob3I+Q293aWUsIE0uIFIuPC9hdXRob3I+PGF1dGhv
cj5QZW5uZWxsLCBELiBKLjwvYXV0aG9yPjxhdXRob3I+UHJhc2FkLCBTLiBLLjwvYXV0aG9yPjwv
YXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkNhcmRpb3Zhc2N1bGFyIE1hZ25l
dGljIFJlc29uYW5jZSBVbml0LCBSb3lhbCBCcm9tcHRvbiBIb3NwaXRhbCwgTG9uZG9uLCBVSy48
L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5Sb2xlIG9mIGNhcmRpb3Zhc2N1bGFyIG1hZ25l
dGljIHJlc29uYW5jZSBhcyBhIGdhdGVrZWVwZXIgdG8gaW52YXNpdmUgY29yb25hcnkgYW5naW9n
cmFwaHkgaW4gcGF0aWVudHMgcHJlc2VudGluZyB3aXRoIGhlYXJ0IGZhaWx1cmUgb2YgdW5rbm93
biBldGlvbG9neTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DaXJjdWxhdGlvbjwvc2Vjb25kYXJ5
LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNpcmN1bGF0aW9uPC9mdWxs
LXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MTM1MS02MDwvcGFnZXM+PHZvbHVtZT4xMjQ8L3Zv
bHVtZT48bnVtYmVyPjEyPC9udW1iZXI+PGVkaXRpb24+MjAxMS8wOS8wOTwvZWRpdGlvbj48a2V5
d29yZHM+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5DYXJkaWFjIEltYWdpbmcgVGVj
aG5pcXVlcy9lY29ub21pY3MvIHN0YW5kYXJkcy9zdGF0aXN0aWNzICZhbXA7IG51bWVyaWNhbCBk
YXRhPC9rZXl3b3JkPjxrZXl3b3JkPkNvcm9uYXJ5IEFuZ2lvZ3JhcGh5L2Vjb25vbWljczwva2V5
d29yZD48a2V5d29yZD5EZWNpc2lvbiBUcmVlczwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tl
eXdvcmQ+PGtleXdvcmQ+Rm9sbG93LVVwIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+R2Fkb2xp
bml1bS9kaWFnbm9zdGljIHVzZTwva2V5d29yZD48a2V5d29yZD5HcmVhdCBCcml0YWluPC9rZXl3
b3JkPjxrZXl3b3JkPkhlYWx0aCBDYXJlIENvc3RzPC9rZXl3b3JkPjxrZXl3b3JkPkhlYXJ0IEZh
aWx1cmUvIGRpYWdub3Npcy9lY29ub21pY3MvIGV0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkh1
bWFuczwva2V5d29yZD48a2V5d29yZD5NYWduZXRpYyBSZXNvbmFuY2UgSW1hZ2luZy9lY29ub21p
Y3MvIHN0YW5kYXJkcy9zdGF0aXN0aWNzICZhbXA7IG51bWVyaWNhbCBkYXRhPC9rZXl3b3JkPjxr
ZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdv
cmQ+T2JzZXJ2ZXIgVmFyaWF0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPlJlZmVycmFsIGFuZCBDb25z
dWx0YXRpb24vZWNvbm9taWNzL3N0YW5kYXJkcy9zdGF0aXN0aWNzICZhbXA7IG51bWVyaWNhbCBk
YXRhPC9rZXl3b3JkPjxrZXl3b3JkPlJlcHJvZHVjaWJpbGl0eSBvZiBSZXN1bHRzPC9rZXl3b3Jk
PjxrZXl3b3JkPlNlbnNpdGl2aXR5IGFuZCBTcGVjaWZpY2l0eTwva2V5d29yZD48L2tleXdvcmRz
PjxkYXRlcz48eWVhcj4yMDExPC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+U2VwIDIwPC9kYXRlPjwv
cHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTUyNC00NTM5IChFbGVjdHJvbmljKSYjeEQ7MDAwOS03
MzIyIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4yMTkwMDA4NTwvYWNjZXNzaW9uLW51
bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExNjEvY2lyY3VsYXRp
b25haGEuMTEwLjAxMTM0NjwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFz
ZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9s
YW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA 39 The authors demonstrated that using CMRI as a gatekeeper to invasive coronary angiography (ICA) was a cheaper diagnostic strategy in a decision tree model when United Kingdom–based costs were assumed, and the sensitivity (100%), specificity (96%), and diagnostic accuracy (97%) of CMRI were equivalent to that of ICA (sensitivity 93%, specificity 96%, diagnostic accuracy 95%).Prognosis: In a recent study conducted by Leong et al (2012) the presence of late gadolinium enhancement (LGE) on CMRI was the only independent predictor of medical therapy failure (i.e. lack of LVEF improvement at follow up) in newly presenting DCM patients when considered with other clinical, echocardiographic and ECG criteria.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZW9uZzwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZW9uZzwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA 35 Leyva et al (2012) demonstrated that LGE on CMRI was an independent predictor of both morbidity and mortality following cardiac resynchronisation therapy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZXl2YTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZXl2YTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA 43 Gulati et al (2013) conducted a prognostic study of 472 consecutive patients with DCM. The authors concluded that CMRI of midwall fibrosis was a predictor of death and cardiovascular hospitalisation, and improved risk stratification beyond left ventricular ejection fraction.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdWxhdGk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdWxhdGk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 44 A systematic review and meta-analysis of the literature demonstrates that late gadolinium enhancement on CMRI predicts adverse cardiovascular outcomes in non-ischemic cardiomyopathy. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdXJ1dmlsbGE8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdXJ1dmlsbGE8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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==
ADDIN EN.CITE.DATA 33Hypertrophic cardiomyopathy/restrictive cardiomyopathyDiagnostic accuracy: In 2004 Moon et al reported 10 patients with the apical variant of HCM, 8 of whom had prior echo examinations which were reported as normal. ADDIN EN.CITE <EndNote><Cite><Author>Moon</Author><Year>2004</Year><RecNum>202</RecNum><DisplayText><style face="superscript">45</style></DisplayText><record><rec-number>202</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1415882217">202</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moon, J. C.</author><author>Fisher, N. G.</author><author>McKenna, W. J.</author><author>Pennell, D. J.</author></authors></contributors><auth-address>Centre for Advanced Magnetic Resonance in Cardiology, Royal Brompton Hospital, London, UK.</auth-address><titles><title>Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography</title><secondary-title>Heart</secondary-title><alt-title>Heart (British Cardiac Society)</alt-title></titles><periodical><full-title>Heart</full-title><abbr-1>Heart (British Cardiac Society)</abbr-1></periodical><alt-periodical><full-title>Heart</full-title><abbr-1>Heart (British Cardiac Society)</abbr-1></alt-periodical><pages>645-9</pages><volume>90</volume><number>6</number><edition>2004/05/18</edition><keywords><keyword>Cardiomyopathy, Hypertrophic/*diagnosis/physiopathology</keyword><keyword>Echocardiography/methods</keyword><keyword>Electrocardiography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Angiography/*methods</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword></keywords><dates><year>2004</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1355-6037</isbn><accession-num>15145868</accession-num><urls></urls><custom2>Pmc1768283</custom2><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>45 CMRI is key in differentiating HCM from "phenocopies" or hearts with similar morphology but profoundly different etiology, ADDIN EN.CITE <EndNote><Cite><Author>Bogaert</Author><Year>2014</Year><RecNum>218</RecNum><DisplayText><style face="superscript">46</style></DisplayText><record><rec-number>218</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1424231233">218</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bogaert, J.</author><author>Olivotto, I.</author></authors></contributors><auth-address>From the Department of Radiology, Gasthuisberg University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium (J.B.); and Referral Center for Myocardial Diseases, Azienda Universitaria Careggi, Florence, Italy (I.O.).</auth-address><titles><title>MR Imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedside</title><secondary-title>Radiology</secondary-title><alt-title>Radiology</alt-title></titles><periodical><full-title>Radiology</full-title><abbr-1>Radiology</abbr-1></periodical><alt-periodical><full-title>Radiology</full-title><abbr-1>Radiology</abbr-1></alt-periodical><pages>329-48</pages><volume>273</volume><number>2</number><edition>2014/10/24</edition><dates><year>2014</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0033-8419</isbn><accession-num>25340269</accession-num><urls></urls><electronic-resource-num>10.1148/radiol.14131626</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>46 such as amyloid or Anderson-Fabry disease, ADDIN EN.CITE <EndNote><Cite><Author>Hoey</Author><Year>2012</Year><RecNum>219</RecNum><DisplayText><style face="superscript">47</style></DisplayText><record><rec-number>219</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1424231276">219</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hoey, E. T.</author><author>Neil-Gallagher, E.</author></authors></contributors><auth-address>Department of Radiology, Heart of England NHS Trust, Heartlands hospital, Bordesley Green East, Birmingham, West Midlands B9 5SS, UK. edwardhoey1@</auth-address><titles><title>Utility of gadolinium enhanced cardiovascular MRI to differentiate Fabry's disease from other causes of hypertrophic cardiomyopathy</title><secondary-title>Postgrad Med J</secondary-title><alt-title>Postgraduate medical journal</alt-title></titles><periodical><full-title>Postgrad Med J</full-title><abbr-1>Postgraduate medical journal</abbr-1></periodical><alt-periodical><full-title>Postgrad Med J</full-title><abbr-1>Postgraduate medical journal</abbr-1></alt-periodical><pages>731-2</pages><volume>88</volume><number>1046</number><edition>2012/07/31</edition><keywords><keyword>Aged</keyword><keyword>Cardiomyopathy, Hypertrophic/classification</keyword><keyword>Diagnosis, Differential</keyword><keyword>Fabry Disease/*diagnosis</keyword><keyword>Gadolinium/*diagnostic use</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging/*methods</keyword><keyword>Male</keyword></keywords><dates><year>2012</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0032-5473</isbn><accession-num>22843677</accession-num><urls></urls><electronic-resource-num>10.1136/postgradmedj-2011-130574</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>47 or amyloidosis. Austin et al (2009) conducted a study of 47 consecutive patients with suspected cardiac amyloidosis. Sensitivity (88%) and specificity (90%) of CMRI was confirmed by myocardial biopsy. At one year follow-up CMRI was a predictor of mortality.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BdXN0aW48L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BdXN0aW48L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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==
ADDIN EN.CITE.DATA 48Change in management: Rickers et al (2005) compared the ability of CMRI and echocardiography to detect increased wall thickness in 48 patients with suspected HCM.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaWNrZXJzPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaWNrZXJzPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE.DATA 49 CMRI was able to detect increased segmental wall thickness in three patients (6%) unidentified by echocardiography, leading to a change in diagnosis and management for a minority of patients. Change in management: The EuroCMR myocarditis / cardiomyopathy population included patients with HCM.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 1 This registry suggested an impact upon patient management (new diagnosis and/or therapeutic consequence) in 55% of these patients. In some cases the suggestion of a restrictive cardiomyopathy relate to myocardial infiltration, such as from iron overload. Change in management: Valente et al (2013) reported that CMRI can identify abnormally thick myocardium in approximately 10% of HCM mutation carriers shown to have normal wall thickness by echocardiography.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYWxlbnRlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYWxlbnRlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE.DATA 50 This is an important study, as the included patients (n=40) were already known to be carriers of an HCM gene. In the Australian setting, where most patients will not have the opportunity to undergo genetic testing for HCM, the identification of subtle phenotypic abnormalities makes the difference between missing the disease and making the appropriate diagnosis. Prognosis: Two recent papers from the US and UK showed that a new CMRI technique of T1 mapping (a marker of myocardial infiltration and expansion of extracellular volume) was an independent predictor of mortality in systemic Amyloidosis.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYW55cGVyc2FkPC9BdXRob3I+PFllYXI+MjAxNTwvWWVh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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYW55cGVyc2FkPC9BdXRob3I+PFllYXI+MjAxNTwvWWVh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==
ADDIN EN.CITE.DATA 51, 52 Arrhythmogenic right ventricular cardiomyopathyChange in management: Taylor et al (2013) investigated the use of CMRI in 732 patients for the investigation of cardiac tumours (n=34), cardiomyopathy (n=488), ARVC (n=118) or viability (n=92). Following the CMRI scan, 37% of patients with a planned implantable device or cardiac surgery based on prior testing did not undergo the intervention.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYXlsb3I8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYXlsb3I8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 53Change in management: Borgquist et al (2014) evaluated the agreement between CMRI and echocardiography for the investigation of suspected ARVC. The findings indicate that up to 50% of ARVC patients would have missed diagnosis if CMRI was not utilised and they had been assessed by echocardiography alone. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Cb3JncXVpc3Q8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Cb3JncXVpc3Q8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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ADDIN EN.CITE.DATA 54Takotsubo cardiomyopathyChange in management: Gerbaud et al (2012) studied 130 patients with troponin-positive chest pain, abnormal ECG changes and no culprit lesion identified by angiography. CMRI enabled a diagnosis in 100 of 130 patients (77%),PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJiYXVkPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJiYXVkPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48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ADDIN EN.CITE.DATA 55 including 37 (28.5%) with acute myocardial infarction, 34 (26.1%) with myocarditis, 28 (21.5%) with apical ballooning syndrome and one (0.8%) with hypertrophic cardiomyopathy. CMRI provided a formal diagnosis in 69% of patients in which the clinical diagnosis was uncertain between at least two possibilities, and corrected a wrong diagnosis in 8% of patients. The CMRI-suggested diagnosis led to a modification of therapy in 42 patients (32%). Change in management: In very recent Australian data (currently unpublished, submitted for peer-review), of 125 consecutive patients presenting to a tertiary centre between 2010 and 2014 with cardiac chest pain, elevated troponin and unobstructed coronaries, CMR provides a definite diagnosis in 87% of these patients. The authors used a panel of three experienced (> 5 years) consultant cardiologists unaware of the CMR diagnosis and blinded to each other’s assessment, who each provided a clinical diagnosis based on clinical, biochemical, ECG, echocardiographic and angiographic findings. A consensus panel diagnosis was defined as two or more cardiologists sharing the same clinical diagnosis. In this study, there was only moderate level of agreement between the three cardiologists (k=0.466, p<0.01) and a poor level of agreement between the consensus panel and CMRI (k=0.38. p<0.01) with the most disagreement seen in patients with non-ST segment elevation myocardial infarction (NSTEMI) diagnosed on CMRI. Hence, CMRI led to a change in management in these patients. Investigation of asymptomatic patients with a family history of sudden cardiac deathThis is a diverse range of patients in whom a first degree relative has died suddenly from a presumed arrhythmia. As such, the group includes patients with a family history that could include HCM, ARVD or DCM, but the exact nature of the underlying abnormality has not been determined in the proband. As it is not clinically feasible to perform genetic testing for each variant of all these conditions, identifying any subtle phenotypic characteristics of mutation carriers is important. Therefore studies considering the utility of CMRI in mutation carriers for these diseases are relevant. Valente et al (2013) showed that CMR can identify abnormally thick myocardium in approximately 10% of HCM mutation carriers who were thought to have normal wall thickness on echocardiography.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYWxlbnRlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYWxlbnRlPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE.DATA 50 This is an important study, as the included patients were already known to be carriers of a HCM gene but judged normal on other testing.In 2013, te Riele et al demonstrated the incremental value of CMRI in arrhythmic risk stratification of ARVC-associated desmosomal mutation carriers.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj50ZSBSaWVsZTwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj50ZSBSaWVsZTwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+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=
ADDIN EN.CITE.DATA 56 Sixty-nine patients with ARVC-associated mutations but had not sustained ventricular arrhythmias were included. Sixty one per cent presented with electrical abnormalities on the basis of electrocardiography and Holter monitoring, of whom 20 (48%) had abnormal results on CMRI. Eleven patients (16%) experienced sustained ventricular arrhythmias, exclusively in patients with both electrical abnormalities (electrocardiography and/or Holter monitoring) and abnormal CMRI results.Mavrogeni et (2013) all applied CMRI to patients with a family history of sudden cardiac death and recent ventricular tachycardia and found the CMR identified abnormalities and provided a diagnosis in 22/25 patients.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXZyb2dlbmk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXZyb2dlbmk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy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ADDIN EN.CITE.DATA 57Provide details on the expected utilisation, if the service is to be publicly funded.Initial uptake of the service will be limited due to the availability of CMRI equipment and staff with suitable training and qualifications. Conventional MRI services are available in private and public facilities across Australia. There are 350 (171 full and 179 partial) Medicare-eligible MRI units in Australia. ADDIN EN.CITE <EndNote><Cite><Author>The Department of Health</Author><Year>2013</Year><RecNum>131</RecNum><DisplayText><style face="superscript">58</style></DisplayText><record><rec-number>131</rec-number><foreign-keys><key app="EN" db-id="f055wwrsv9paxvedtx1xvvazze0zw95trsr9" timestamp="1393980903">131</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>The Department of Health,</author></authors></contributors><titles><title>Magnetic Resonance Imaging (MRI)</title></titles><volume>2014</volume><number>5 March</number><dates><year>2013</year><pub-dates><date>13 December 2013</date></pub-dates></dates><publisher>The Department of Health</publisher><urls><related-urls><url> The capacity for CMRI is currently unknown, however, as there are no mechanisms for registering the number of MRI machines equipped with specialised cardiac software. The requirement for a minimum level of training for radiologists is encouraged by the Department. This will have an impact on the initial availability of CMRI services, however, as it is presumed that few Australian radiologists have attained these qualifications to date. Based on the limited use of CMRI in State-based and private hospitals, the Applicant estimates that there are 20 to 25 sites in Australia that have dedicated cardiac software, and technologists and physicians with the requisite experience to conduct CMRI scans. This is likely to be a limiting factor in the initial uptake of the proposed service.Due to the uncertain incidence and prevalence of cardiomyopathies in the Australian population, it is difficult to accurately estimate the likely uptake of the proposed service in the context of available MRI machines and suitably qualified staff. In addition, the number of patients with heart failure symptoms who are contraindicated for CMRI due to an implantable cardiac defibrillator is also difficult to estimate.Population OnePopulation One includes two subgroups of patients with suspected dilated cardiomyopathy:Patients presenting with heart failure symptoms, in whom echocardiography is inconclusive or suggests a dilated cardiomyopathy, and in whom further diagnostic clarification is required.Asymptomatic individuals with a family history of non-ischaemic dilated cardiomyopathy in a first-degree relative in whom echocardiography is inconclusive.Clinical claim for the proposed interventionCMRI in patients with suspected DCM provides information regarding left ventricular morphology and tissue characterisation. It is recognised as providing more accurate information than echocardiography in the assessment of left ventricular structure and function. In addition, CMRI may help identify the aetiology of the DCM through tissue characterisation with late gadolinium enhancement (LGE). LGE is able to demonstrate different patterns of myocardial scarring for different aetiologies of DCM. For example, a sub-endocardial pattern on LGE indicates scarring from a prior myocardial infarction, showing that the cardiomyopathy relates to CAD. Current standard practice employs a coronary angiogram as the main method to identify patients for whom CAD was the culprit for LV dysfunction. Published CMRI data has shown, however, that using the coronary angiogram as the arbiter for the presence of LV dysfunction caused by CAD could have led to an incorrect assignment of the cause of DCM in 13% of patients.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY0Nyb2hvbjwvQXV0aG9yPjxZZWFyPjIwMDM8L1llYXI+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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY0Nyb2hvbjwvQXV0aG9yPjxZZWFyPjIwMDM8L1llYXI+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=
ADDIN EN.CITE.DATA 42 The detection of mid-wall fibrosis—present in approximately 30% of DCM patients—has a role in the risk stratification of patients, as fibrosis is a predictor of all-cause mortality and cardiovascular hospitalisation. Mid-wall LGE also predicts ventricular tachycardia and sudden cardiac death.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdWxhdGk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
ZWNOdW0+NTA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij40
NDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjUwPC9yZWMtbnVtYmVy
Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icjV6enY5OTluejJzZG5ldnp6enZm
ZDBpeDB2enR6ZmR4MHNyIiB0aW1lc3RhbXA9IjE0MTM0OTY5OTgiPjUwPC9rZXk+PGtleSBhcHA9
IkVOV2ViIiBkYi1pZD0iIj4wPC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9Ikpv
dXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhv
cj5HdWxhdGksIEEuPC9hdXRob3I+PGF1dGhvcj5KYWJib3VyLCBBLjwvYXV0aG9yPjxhdXRob3I+
SXNtYWlsLCBULiBGLjwvYXV0aG9yPjxhdXRob3I+R3VoYSwgSy48L2F1dGhvcj48YXV0aG9yPkto
d2FqYSwgSi48L2F1dGhvcj48YXV0aG9yPlJhemEsIFMuPC9hdXRob3I+PGF1dGhvcj5Nb3Jhcmpp
LCBLLjwvYXV0aG9yPjxhdXRob3I+QnJvd24sIFQuIEQuPC9hdXRob3I+PGF1dGhvcj5Jc21haWws
IE4uIEEuPC9hdXRob3I+PGF1dGhvcj5Ed2VjaywgTS4gUi48L2F1dGhvcj48YXV0aG9yPkRpIFBp
ZXRybywgRS48L2F1dGhvcj48YXV0aG9yPlJvdWdodG9uLCBNLjwvYXV0aG9yPjxhdXRob3I+V2Fn
ZSwgUi48L2F1dGhvcj48YXV0aG9yPkRhcnlhbmksIFkuPC9hdXRob3I+PGF1dGhvcj5PJmFwb3M7
SGFubG9uLCBSLjwvYXV0aG9yPjxhdXRob3I+U2hlcHBhcmQsIE0uIE4uPC9hdXRob3I+PGF1dGhv
cj5BbHBlbmR1cmFkYSwgRi48L2F1dGhvcj48YXV0aG9yPkx5b24sIEEuIFIuPC9hdXRob3I+PGF1
dGhvcj5Db29rLCBTLiBBLjwvYXV0aG9yPjxhdXRob3I+Q293aWUsIE0uIFIuPC9hdXRob3I+PGF1
dGhvcj5Bc3NvbXVsbCwgUi4gRy48L2F1dGhvcj48YXV0aG9yPlBlbm5lbGwsIEQuIEouPC9hdXRo
b3I+PGF1dGhvcj5QcmFzYWQsIFMuIEsuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3Jz
PjxhdXRoLWFkZHJlc3M+Um95YWwgQnJvbXB0b24gSG9zcGl0YWwsIExvbmRvbiwgRW5nbGFuZC48
L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5Bc3NvY2lhdGlvbiBvZiBmaWJyb3NpcyB3aXRo
IG1vcnRhbGl0eSBhbmQgc3VkZGVuIGNhcmRpYWMgZGVhdGggaW4gcGF0aWVudHMgd2l0aCBub25p
c2NoZW1pYyBkaWxhdGVkIGNhcmRpb215b3BhdGh5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkpB
TUE8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkpBTUE8L2FsdC10aXRsZT48L3RpdGxlcz48
cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5KYW1hPC9mdWxsLXRpdGxlPjxhYmJyLTE+SmFtYTwvYWJi
ci0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SmFtYTwvZnVsbC10
aXRsZT48YWJici0xPkphbWE8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz44OTYtOTA4
PC9wYWdlcz48dm9sdW1lPjMwOTwvdm9sdW1lPjxudW1iZXI+OTwvbnVtYmVyPjxlZGl0aW9uPjIw
MTMvMDMvMDc8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3
b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2FyZGlvbXlvcGF0aHksIERpbGF0ZWQvKm1vcnRh
bGl0eS8qcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkNhdXNlIG9mIERlYXRoPC9rZXl3b3Jk
PjxrZXl3b3JkPkRlYXRoLCBTdWRkZW4sIENhcmRpYWMvKmVwaWRlbWlvbG9neTwva2V5d29yZD48
a2V5d29yZD5EZWZpYnJpbGxhdG9ycywgSW1wbGFudGFibGU8L2tleXdvcmQ+PGtleXdvcmQ+RmVt
YWxlPC9rZXl3b3JkPjxrZXl3b3JkPkZpYnJvc2lzPC9rZXl3b3JkPjxrZXl3b3JkPkdhZG9saW5p
dW0vZGlhZ25vc3RpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+R3JlYXQgQnJpdGFpbi9lcGlkZW1p
b2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1hZ25ldGlj
IFJlc29uYW5jZSBJbWFnaW5nPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdv
cmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+TXlvY2FyZGl1bS8qcGF0aG9sb2d5PC9r
ZXl3b3JkPjxrZXl3b3JkPlBhdGllbnQgU2VsZWN0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPlByZWRp
Y3RpdmUgVmFsdWUgb2YgVGVzdHM8L2tleXdvcmQ+PGtleXdvcmQ+UHJvZ25vc2lzPC9rZXl3b3Jk
PjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+UmlzayBBc3Nl
c3NtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlN0cm9rZSBWb2x1bWU8L2tleXdvcmQ+PGtleXdvcmQ+
KlZlbnRyaWN1bGFyIEZ1bmN0aW9uLCBMZWZ0PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5
ZWFyPjIwMTM8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXIgNjwvZGF0ZT48L3B1Yi1kYXRlcz48
L2RhdGVzPjxpc2JuPjAwOTgtNzQ4NDwvaXNibj48YWNjZXNzaW9uLW51bT4yMzQ2Mjc4NjwvYWNj
ZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMDEv
amFtYS4yMDEzLjEzNjM8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2Ut
cHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFu
Z3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdWxhdGk8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
ZWNOdW0+NTA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij40
NDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjUwPC9yZWMtbnVtYmVy
Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icjV6enY5OTluejJzZG5ldnp6enZm
ZDBpeDB2enR6ZmR4MHNyIiB0aW1lc3RhbXA9IjE0MTM0OTY5OTgiPjUwPC9rZXk+PGtleSBhcHA9
IkVOV2ViIiBkYi1pZD0iIj4wPC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9Ikpv
dXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhv
cj5HdWxhdGksIEEuPC9hdXRob3I+PGF1dGhvcj5KYWJib3VyLCBBLjwvYXV0aG9yPjxhdXRob3I+
SXNtYWlsLCBULiBGLjwvYXV0aG9yPjxhdXRob3I+R3VoYSwgSy48L2F1dGhvcj48YXV0aG9yPkto
d2FqYSwgSi48L2F1dGhvcj48YXV0aG9yPlJhemEsIFMuPC9hdXRob3I+PGF1dGhvcj5Nb3Jhcmpp
LCBLLjwvYXV0aG9yPjxhdXRob3I+QnJvd24sIFQuIEQuPC9hdXRob3I+PGF1dGhvcj5Jc21haWws
IE4uIEEuPC9hdXRob3I+PGF1dGhvcj5Ed2VjaywgTS4gUi48L2F1dGhvcj48YXV0aG9yPkRpIFBp
ZXRybywgRS48L2F1dGhvcj48YXV0aG9yPlJvdWdodG9uLCBNLjwvYXV0aG9yPjxhdXRob3I+V2Fn
ZSwgUi48L2F1dGhvcj48YXV0aG9yPkRhcnlhbmksIFkuPC9hdXRob3I+PGF1dGhvcj5PJmFwb3M7
SGFubG9uLCBSLjwvYXV0aG9yPjxhdXRob3I+U2hlcHBhcmQsIE0uIE4uPC9hdXRob3I+PGF1dGhv
cj5BbHBlbmR1cmFkYSwgRi48L2F1dGhvcj48YXV0aG9yPkx5b24sIEEuIFIuPC9hdXRob3I+PGF1
dGhvcj5Db29rLCBTLiBBLjwvYXV0aG9yPjxhdXRob3I+Q293aWUsIE0uIFIuPC9hdXRob3I+PGF1
dGhvcj5Bc3NvbXVsbCwgUi4gRy48L2F1dGhvcj48YXV0aG9yPlBlbm5lbGwsIEQuIEouPC9hdXRo
b3I+PGF1dGhvcj5QcmFzYWQsIFMuIEsuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3Jz
PjxhdXRoLWFkZHJlc3M+Um95YWwgQnJvbXB0b24gSG9zcGl0YWwsIExvbmRvbiwgRW5nbGFuZC48
L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5Bc3NvY2lhdGlvbiBvZiBmaWJyb3NpcyB3aXRo
IG1vcnRhbGl0eSBhbmQgc3VkZGVuIGNhcmRpYWMgZGVhdGggaW4gcGF0aWVudHMgd2l0aCBub25p
c2NoZW1pYyBkaWxhdGVkIGNhcmRpb215b3BhdGh5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkpB
TUE8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkpBTUE8L2FsdC10aXRsZT48L3RpdGxlcz48
cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5KYW1hPC9mdWxsLXRpdGxlPjxhYmJyLTE+SmFtYTwvYWJi
ci0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SmFtYTwvZnVsbC10
aXRsZT48YWJici0xPkphbWE8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz44OTYtOTA4
PC9wYWdlcz48dm9sdW1lPjMwOTwvdm9sdW1lPjxudW1iZXI+OTwvbnVtYmVyPjxlZGl0aW9uPjIw
MTMvMDMvMDc8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3
b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2FyZGlvbXlvcGF0aHksIERpbGF0ZWQvKm1vcnRh
bGl0eS8qcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkNhdXNlIG9mIERlYXRoPC9rZXl3b3Jk
PjxrZXl3b3JkPkRlYXRoLCBTdWRkZW4sIENhcmRpYWMvKmVwaWRlbWlvbG9neTwva2V5d29yZD48
a2V5d29yZD5EZWZpYnJpbGxhdG9ycywgSW1wbGFudGFibGU8L2tleXdvcmQ+PGtleXdvcmQ+RmVt
YWxlPC9rZXl3b3JkPjxrZXl3b3JkPkZpYnJvc2lzPC9rZXl3b3JkPjxrZXl3b3JkPkdhZG9saW5p
dW0vZGlhZ25vc3RpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+R3JlYXQgQnJpdGFpbi9lcGlkZW1p
b2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1hZ25ldGlj
IFJlc29uYW5jZSBJbWFnaW5nPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdv
cmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+TXlvY2FyZGl1bS8qcGF0aG9sb2d5PC9r
ZXl3b3JkPjxrZXl3b3JkPlBhdGllbnQgU2VsZWN0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPlByZWRp
Y3RpdmUgVmFsdWUgb2YgVGVzdHM8L2tleXdvcmQ+PGtleXdvcmQ+UHJvZ25vc2lzPC9rZXl3b3Jk
PjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+UmlzayBBc3Nl
c3NtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlN0cm9rZSBWb2x1bWU8L2tleXdvcmQ+PGtleXdvcmQ+
KlZlbnRyaWN1bGFyIEZ1bmN0aW9uLCBMZWZ0PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5
ZWFyPjIwMTM8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXIgNjwvZGF0ZT48L3B1Yi1kYXRlcz48
L2RhdGVzPjxpc2JuPjAwOTgtNzQ4NDwvaXNibj48YWNjZXNzaW9uLW51bT4yMzQ2Mjc4NjwvYWNj
ZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMDEv
amFtYS4yMDEzLjEzNjM8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2Ut
cHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFu
Z3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=
ADDIN EN.CITE.DATA 44Data from the pilot phase of the EuroCMR registry demonstrates the potential impact that CMRI may have on patient management,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 1 showing that 55% of patients undergoing CMRI for suspected cardiomyopathy or myocarditis had a change in diagnosis or therapy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 1 In 16% of cases the final diagnosis based on CMRI was different to the diagnosis before CMRI. Identifying the correct underlying aetiology is likely to improve patient outcomes and reduce downstream costs. There are benefits of CMRI in terms of diagnostic accuracy compared to comparators. For example the 13% of patients with a previously unrecognized ischaemic cardiomyopathy may benefit from revascularization and medications for secondary prevention of coronary atherosclerosis. Family members of patients with a defined cause of DCM, such as ischaemic cardiomyopathy, myocarditis, and sarcoid, would not require screening for DCM. Beyond the diagnostic accuracy for identifying DCM, a key benefit of CMRI is the ability to define the aetiology and hence alter patient management. It is challenging to define how frequently this might occur and how patient management might change following the CMRI scan. Yoshida et al (2013) performed a direct comparison of the diagnostic capability of cardiac magnetic resonance and endomyocardial biopsy (EMB) in patients with heart failure.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Zb3NoaWRhPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Zb3NoaWRhPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE.DATA 59 From a group of 1034 patients with heart failure of unknown aetiology, 180 patients underwent both CMRI and EMB. The utility of CMRI in identifying new cardiac diagnosis is demonstrated by the identification of patients from this DCM group who would be classified into other populations (HCM, ARVC) for this proposal. Importantly, all of the patients who received accurate diagnoses with EMB alone were also correctly diagnosed using the combined diagnosis with clinical data, echocardiogram, plus CMRI. In this group, 26% of patients (n=36) were diagnosed with hypertrophic cardiomyopathy, with 15 cases in the dilated phase of HCM. Cardiac MRI identified 13 cases of sarcoidosis, five cases of ARVD, one case of myocarditis and three cases of amyloidosis.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Zb3NoaWRhPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Zb3NoaWRhPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE.DATA 59The benefits of CMRI in terms of any potential change in management compared to comparators can be difficult to quantify, particularly if the MRI results in a new diagnosis. Eligibility for an implantable defibrillator provides one such example. In patients with a left ventricular ejection fraction less than 30%, (or less than 35% depending upon the aetiology and guideline) an implantable cardiac defibrillator (ICD) is indicated. The study by Joshi et al (2012) reviewed the potential clinical impact of cardiovascular magnetic resonance assessment of ejection fraction compared to echo ejection fraction (EF) on eligibility for ICD implantation.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Kb3NoaTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl
Y051bT4yMjQ8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij42
MDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIyNDwvcmVjLW51bWJl
cj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InI1enp2OTk5bnoyc2RuZXZ6enp2
ZmQwaXgwdnp0emZkeDBzciIgdGltZXN0YW1wPSIxNDI0MjMyODk3Ij4yMjQ8L2tleT48L2ZvcmVp
Z24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNv
bnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkpvc2hpLCBTLiBCLjwvYXV0aG9yPjxhdXRob3I+
Q29ubmVsbHksIEsuIEEuPC9hdXRob3I+PGF1dGhvcj5KaW1lbmV6LUp1YW4sIEwuPC9hdXRob3I+
PGF1dGhvcj5IYW5zZW4sIE0uPC9hdXRob3I+PGF1dGhvcj5LaXJwYWxhbmksIEEuPC9hdXRob3I+
PGF1dGhvcj5Eb3JpYW4sIFAuPC9hdXRob3I+PGF1dGhvcj5NYW5nYXQsIEkuPC9hdXRob3I+PGF1
dGhvcj5BbC1IZXNheWVuLCBBLjwvYXV0aG9yPjxhdXRob3I+Q3JlYW4sIEEuIE0uPC9hdXRob3I+
PGF1dGhvcj5XcmlnaHQsIEcuIEEuPC9hdXRob3I+PGF1dGhvcj5ZYW4sIEEuIFQuPC9hdXRob3I+
PGF1dGhvcj5MZW9uZy1Qb2ksIEguPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxh
dXRoLWFkZHJlc3M+S2VlbmFuIFJlc2VhcmNoIENlbnRyZSBhdCB0aGUgTGkgS2EgU2hpbmcgS25v
d2xlZGdlIEluc3RpdHV0ZSwgRGl2aXNpb24gb2YgQ2FyZGlvbG9neSwgU3QgTWljaGFlbCZhcG9z
O3MgSG9zcGl0YWwsIFVuaXZlcnNpdHkgb2YgVG9yb250bywgMzAgQm9uZCBTdCwgVG9yb250bywg
T04sIE01QiAxVzgsIENhbmFkYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5Qb3RlbnRp
YWwgY2xpbmljYWwgaW1wYWN0IG9mIGNhcmRpb3Zhc2N1bGFyIG1hZ25ldGljIHJlc29uYW5jZSBh
c3Nlc3NtZW50IG9mIGVqZWN0aW9uIGZyYWN0aW9uIG9uIGVsaWdpYmlsaXR5IGZvciBjYXJkaW92
ZXJ0ZXIgZGVmaWJyaWxsYXRvciBpbXBsYW50YXRpb248L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+
SiBDYXJkaW92YXNjIE1hZ24gUmVzb248L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkpvdXJu
YWwgb2YgY2FyZGlvdmFzY3VsYXIgbWFnbmV0aWMgcmVzb25hbmNlIDogb2ZmaWNpYWwgam91cm5h
bCBvZiB0aGUgU29jaWV0eSBmb3IgQ2FyZGlvdmFzY3VsYXIgTWFnbmV0aWMgUmVzb25hbmNlPC9h
bHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBDYXJkaW92YXNjIE1h
Z24gUmVzb248L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz42OTwvcGFnZXM+PHZvbHVt
ZT4xNDwvdm9sdW1lPjxlZGl0aW9uPjIwMTIvMTAvMTA8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3
b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+RGVhdGgsIFN1ZGRlbiwgQ2FyZGlhYy9ldGlvbG9n
eS8qcHJldmVudGlvbiAmYW1wOyBjb250cm9sPC9rZXl3b3JkPjxrZXl3b3JkPipEZWZpYnJpbGxh
dG9ycywgSW1wbGFudGFibGU8L2tleXdvcmQ+PGtleXdvcmQ+RWNob2NhcmRpb2dyYXBoeTwva2V5
d29yZD48a2V5d29yZD5FbGVjdHJpYyBDb3VudGVyc2hvY2svKmluc3RydW1lbnRhdGlvbjwva2V5
d29yZD48a2V5d29yZD5FbGlnaWJpbGl0eSBEZXRlcm1pbmF0aW9uPC9rZXl3b3JkPjxrZXl3b3Jk
PkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+Kk1hZ25l
dGljIFJlc29uYW5jZSBJbWFnaW5nPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtl
eXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+T2JzZXJ2ZXIgVmFyaWF0aW9uPC9r
ZXl3b3JkPjxrZXl3b3JkPk9udGFyaW88L2tleXdvcmQ+PGtleXdvcmQ+UGF0aWVudCBTZWxlY3Rp
b248L2tleXdvcmQ+PGtleXdvcmQ+UHJlZGljdGl2ZSBWYWx1ZSBvZiBUZXN0czwva2V5d29yZD48
a2V5d29yZD5SZXByb2R1Y2liaWxpdHkgb2YgUmVzdWx0czwva2V5d29yZD48a2V5d29yZD4qU3Ry
b2tlIFZvbHVtZTwva2V5d29yZD48a2V5d29yZD5UaHJvbWJvc2lzL2NvbXBsaWNhdGlvbnMvZGlh
Z25vc2lzL3BoeXNpb3BhdGhvbG9neS90aGVyYXB5PC9rZXl3b3JkPjxrZXl3b3JkPlZlbnRyaWN1
bGFyIER5c2Z1bmN0aW9uLCBMZWZ0L2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npcy9waHlzaW9wYXRo
b2xvZ3kvKnRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+KlZlbnRyaWN1bGFyIEZ1bmN0aW9uLCBM
ZWZ0PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTI8L3llYXI+PC9kYXRlcz48
aXNibj4xMDk3LTY2NDc8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjMwNDM3Mjk8L2FjY2Vzc2lvbi1u
dW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBtYzM0ODIzODk8L2N1c3RvbTI+PGVsZWN0cm9uaWMt
cmVzb3VyY2UtbnVtPjEwLjExODYvMTUzMi00Mjl4LTE0LTY5PC9lbGVjdHJvbmljLXJlc291cmNl
LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp
ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Kb3NoaTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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 EN.CITE.DATA 60 Among patients with an echocardiographic EF of between 25% and 40%, they found that 41% were reclassified by CMRI. In addition, echocardiography identified only one of the six patients with left ventricular thrombus noted on CMRI. The presence of LV thrombus would usually require anticoagulation in a newly diagnosed cardiomyopathy patient, although the situation is less clear for chronic DCM patients. However, left ventricular thrombus may be of greater clinical importance in ICD patients, as defibrillation threshold testing following implantation would generally be avoided due to the risk of embolisation. At the EF threshold of 35%, CMRI reclassified 11 of 52 (21%) of patients with respect to eligibility for ICD. In 10 of the 11 instances of reclassification, CMRI found the EF to be below 35% making the patient potentially ICD-eligible, although one patient would avoid unnecessary ICD implantation.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Kb3NoaTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Kb3NoaTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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 EN.CITE.DATA 60 The change in management for a new diagnosis post-CMRI would depend upon the exact nature of the new diagnosis. Assuming that myocarditis, sarcoidosis and amyloidosis are potentially treatable if identified early, using the data from Yoshida’s study, 12.5% of patients (17/136) would have a treatable cause of DCM identified.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Zb3NoaWRhPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Zb3NoaWRhPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48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ADDIN EN.CITE.DATA 59 Appropriate therapy could reverse the cardiomyopathy and avoid the need for family screening. The benefits of the change in management to patient health outcomes is similarly difficult to define. Considering the patients with a new diagnosis that may be treatable, cardiac MRI has the potential to be lifesaving. Cardiac amyloid typically causes increased wall thickness and so is considered in the HCM section of this protocol, but and also present as a DCM. In amyloid light-chain (AL) amyloidosis, the commonest form of amyloid, cardiac involvement is frequent and is the cause of death in most of patients. Effective treatments for AL amyloidosis are available, but treatment options are limited when the myocardial disease is advanced. It is expected that CMRI will identify the majority of cardiac amyloid patients and some of those will be amenable to treatment. Importantly, the identification of cardiac amyloid may allow the patient to avoid other therapies and investigations, such as ICD (when their prognosis is grim due to advanced disease).In summary, the proposed benefits of CMRI in patients with suspected DCM include:Increased diagnostic sensitivity compared to the current non-invasive techniques of investigating and differentiating DCM.Increased safety compared to invasive coronary angiography, myocardial perfusion scans or CTCA including the avoidance of ionising tests (radiation) and subsequent cancers.Potential change in patient management in more than 50% of patients. This may be due to increased diagnostic sensitivity, leading to a change in diagnosis and treatment pathway. In around one in seven patients from the Euro CMR registry, CMRI resulted in a different final diagnosis.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnVkZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 1Potential avoidance of invasive coronary angiography or parator(s)The main comparators that CMRI will potentially replace, i.e. tests that would otherwise be used to investigate patients with an abnormal echocardiography result, but in whom further information is required to confirm the aetiology of the disease, include:Invasive coronary angiography with or without left ventricular angiogram (MBS Items 38215-38246)Invasive coronary angiography (ICA) is currently the gold standard used to rule out ischaemic causes of DCM. In this regard, ICA is used in Population One to discount CAD as the primary source of a patient’s heart failure symptoms. Due to its invasiveness, ICA is only recommended in patients with stable symptoms, and only when non-invasive testing provides inadequate information to determine the likelihood of a cardiac event as a result of CAD.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb250YWxlc2NvdDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb250YWxlc2NvdDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll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ADDIN EN.CITE.DATA 61Computed tomography coronary angiography (CTCA) (MBS Items 57360, 57361)CTCA utilises intravenous contrast to visualise the lumen of coronary arteries, enabling diagnosis of ischaemic causes of left ventricular dilation. The primary use in Population One is to rule out ischaemic causes of DCM. The use of CT to image coronary arteries may avoid the use of invasive coronary catheterisation, however, the use of CTCA is not recommended in patients who are obese, cannot hold a breath, have high calcium scores (e.g. Agatston score > 400), or a regular heart rate greater than 65 beats per minute.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb250YWxlc2NvdDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb250YWxlc2NvdDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll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ADDIN EN.CITE.DATA 61 CTCA is primarily indicated for patients who have a low intermediate pre-test probability of CAD (15-45%). ADDIN EN.CITE <EndNote><Cite><Author>Paech</Author><Year>2011</Year><RecNum>200</RecNum><DisplayText><style face="superscript">62</style></DisplayText><record><rec-number>200</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1415768281">200</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Paech, D. C.</author><author>Weston, A. R.</author></authors></contributors><auth-address>Health Technology Analysts Pty Ltd, 135 Rowntree St, Balmain, NSW 2041, Australia. dpaech@</auth-address><titles><title>A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease</title><secondary-title>BMC Cardiovasc Disord</secondary-title><alt-title>BMC cardiovascular disorders</alt-title></titles><periodical><full-title>BMC Cardiovasc Disord</full-title><abbr-1>BMC cardiovascular disorders</abbr-1></periodical><alt-periodical><full-title>BMC Cardiovasc Disord</full-title><abbr-1>BMC cardiovascular disorders</abbr-1></alt-periodical><pages>32</pages><volume>11</volume><edition>2011/06/18</edition><keywords><keyword>Coronary Angiography/*standards</keyword><keyword>Coronary Artery Disease/*radiography/therapy</keyword><keyword>Humans</keyword><keyword>Prospective Studies</keyword><keyword>Tomography, X-Ray Computed/*standards</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2011</year></dates><isbn>1471-2261</isbn><accession-num>21679468</accession-num><urls></urls><custom2>Pmc3141758</custom2><electronic-resource-num>10.1186/1471-2261-11-32</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>62Exercise or pharmacologic (adenosine or dobutamine) single-photon emission computed tomography (SPECT) (MBS Items 61302, 61303, 61306, 61307, 61651, 61652, 61653, 61654)SPECT utilises technetium-99m or thallium-201 radiopharmaceutical tracers to visualise regional myocardial blood flow and perfusion.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb250YWxlc2NvdDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb250YWxlc2NvdDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll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ADDIN EN.CITE.DATA 61 Regional areas affected by myocardial ischaemia are identified by monitoring tracer uptake under peak stress (either pharmacological or exercise) compared to baseline uptake during rest. In Population One, SPECT is used to rule-out ischaemic causes of DCM.Watchful waitingThe Applicant suggests that in current clinical practice the majority of patients with suspected DCM will proceed directly to medical therapy with follow-up monitoring on the basis of clinical history, ECG and echocardiography results. In such cases, the aetiology of the disease may be unknown, and medical treatment may be ineffective if the cause of DCM is unclear. First degree relatives of the DCM patient should undergo screening if an inherited cause cannot be excluded.Reference standard(s) The reference standard for differentiating non-ischaemic DCM from an ischaemic DCM would be invasive coronary angiography, although SPECT and CT coronary angiography would sometimes be utilised. Once coronary artery disease has been excluded, aetiology of a non-ischaemic DCM can be sought by either myocardial biopsy or genetic testing, depending on the suspected aetiology of the disease. In Australian clinical practice, a diagnosis of familial DCM is often confirmed by the presence of DCM in patients with a family history in two first-degree relatives, or through genetic testing for known mutations. ADDIN EN.CITE <EndNote><Cite><Author>Fatkin</Author><Year>2011</Year><RecNum>6</RecNum><DisplayText><style face="superscript">63</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126403">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fatkin, D.</author></authors></contributors><auth-address>Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, 405 Liverpool Street, Darlinghurst, NSW 2010, Australia. d.fatkin@victorchang.edu.au</auth-address><titles><title>Guidelines for the diagnosis and management of familial dilated cardiomyopathy</title><secondary-title>Heart Lung Circ</secondary-title></titles><periodical><full-title>Heart Lung Circ</full-title></periodical><pages>691-3</pages><volume>20</volume><number>11</number><edition>2011/09/03</edition><keywords><keyword>Cardiomyopathy, Dilated/diagnosis/drug therapy/genetics/physiopathology</keyword><keyword>Echocardiography/methods</keyword><keyword>Electrocardiography/methods</keyword><keyword>Female</keyword><keyword>Genetic Testing/methods</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mutation</keyword><keyword>Practice Guidelines as Topic</keyword></keywords><dates><year>2011</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1444-2892 (Electronic)
1443-9506 (Linking)</isbn><accession-num>21885340</accession-num><urls></urls><electronic-resource-num>10.1016/j.hlc.2011.07.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>63 PASC recognises that for DCM these reference standards are imperfect.Clinical pathwayIn this population, CMRI is primarily intended to be used as an adjunct diagnostic tool to clinical examination, chest x-ray and echocardiography. Echocardiography would typically be expected to show impaired LV function with a dilated left ventricle. CMRI would then be requested to further clarify the diagnosis, and in some cases also inform prognosis and the investigation of first degree relatives (see Figure 2). For example, in a patient with a dilated LV with poor systolic function identified on echocardiography, CMRI could show typical changes of an acute myocarditis, post myocarditis fibrosis, unsuspected ischaemic damage , or alternatively indicate an idiopathic/familial pattern of fibrosis. The investigation of first degree relatives would be triggered by the second finding but prevented by the first. Echocardiography alone would be unable to distinguish between these diagnoses. In addition to adjunct diagnosis, CMRI has the potential to act as a gatekeeper to invasive coronary angiography, as discussed earlier.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA 39 The clinical pathway for suspected DCM is informed by the European Society of Cardiology’s clinical practice guidelines for the diagnosis and treatment of acute and chronic heart failure.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY011cnJheTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NY011cnJheTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+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==
ADDIN EN.CITE.DATA 64Figure SEQ Figure \* ARABIC 1: Proposed clinical practice algorithm for the investigation of suspected DCMCTCA=computed tomography coronary angiography, DCM=dilated cardiomyopathy, ECG=electrocardiography, ICA=invasive coronary angiography, ICD=implantable cardioverter defibrillator, MRI=magnetic resonance imaging, OMT=optimal medical therapy, SPECT=single-photon emission computed tomography. Population One also includes a subgroup of asymptomatic patients with a family history of DCM in a first-degree relative. In this population, CMRI is intended to be used as an adjunct diagnostic tool to confirm the diagnosis and establish the aetiology of DCM. The pathway for the investigation of first degree relatives of patients with DCM is informed by clinical practice guidelines published by CSANZ. ADDIN EN.CITE <EndNote><Cite><Author>Fatkin</Author><Year>2011</Year><RecNum>6</RecNum><DisplayText><style face="superscript">63</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1412126403">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fatkin, D.</author></authors></contributors><auth-address>Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, 405 Liverpool Street, Darlinghurst, NSW 2010, Australia. d.fatkin@victorchang.edu.au</auth-address><titles><title>Guidelines for the diagnosis and management of familial dilated cardiomyopathy</title><secondary-title>Heart Lung Circ</secondary-title></titles><periodical><full-title>Heart Lung Circ</full-title></periodical><pages>691-3</pages><volume>20</volume><number>11</number><edition>2011/09/03</edition><keywords><keyword>Cardiomyopathy, Dilated/diagnosis/drug therapy/genetics/physiopathology</keyword><keyword>Echocardiography/methods</keyword><keyword>Electrocardiography/methods</keyword><keyword>Female</keyword><keyword>Genetic Testing/methods</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mutation</keyword><keyword>Practice Guidelines as Topic</keyword></keywords><dates><year>2011</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1444-2892 (Electronic)
1443-9506 (Linking)</isbn><accession-num>21885340</accession-num><urls></urls><electronic-resource-num>10.1016/j.hlc.2011.07.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>63Figure SEQ Figure \* ARABIC 2: Proposed clinical practice algorithm for the investigation of asymptomatic patients with a family history of DCM in a first-degree relative.DCM=dilated cardiomyopathy, ECG=electrocardiography, ICD=implantable cardioverter defibrillator, MRI=magnetic resonance imaging, OMT=optimal medical therapy.Health outcomesRelevant health outcomes for the investigation of CMRI in patients with suspected DCM are outlined in Table 2.Economic evaluationThe economic evaluation for the proposed service is informed by the following clinical claims:Superior safety and non-inferior effectiveness compared to invasive coronary angiography.Superior safety and superior effectiveness compared to CTCA.Non-inferior safety and superior effectiveness compared to medical management without further testing.In this context, the economic evaluation of the proposed service will be a cost-effectiveness analysis/cost-utility analysis.Summary of PICO criteriaTable SEQ Table \* ARABIC 2: Summary of PICO to define the research question(s) for Population OnePICO CriteriaCommentsPatientsPatients presenting with heart failure symptoms, in whom echocardiography is inconclusive or suggests a dilated cardiomyopathy, and in whom further diagnostic clarification is required.Asymptomatic individuals with a family history of non-ischaemic dilated cardiomyopathy in a first-degree relative in whom echocardiography is inconclusive.InterventionMRI assessment of myocardial structure and function, including tissue characterisationComparatorAngiography (MBS Items 38215-38246)CTCA (MBS Items 57360, 57361) SPECT (MBS Items 61302, 61303, 1306, 61307, 61651, 61652, 61653, 61654)Watchful waiting in the context of optimal medical therapyOutcomesSafetyGadolinium contrast adverse reactionClaustrophobiaPhysical harms from follow-up testingOther adverse events arising from CMRIEffectivenessHealth outcomesCardiac disease-specific mortalitySurvivalCardiac hospitalisationAdverse cardiac event over defined periodQuality of life scoresDiagnostic accuracySensitivity, specificity (confirmed by reference standard)Positive predictive value, negative predictive value (confirmed by reference standard)Positive likelihood ratio, negative likelihood ratio (confirmed by reference standard)ROC curvesUnsatisfactory or uninterpretable test resultsPatient managementChange in clinical diagnosisChange in treatment pathway (initiated, ceased, modified, avoided)Patient compliance with, preference for imagingTime to initial diagnosisTime from diagnosis to treatmentRates of re-interventionCost-effectivenessCostCost per quality adjusted life year or disability adjusted life yearIncremental cost-effectiveness ratioPrior testsClinical examination Echocardiography (MBS Items 55113, 55115)ECG (MBS Items 11700, 11701, 11702)Reference testMyocardial biopsy (MBS Item 38275) or genetic testing.Research question for assessment: In patients with a family history of DCM in whom echocardiography is inconclusive, or in patients with heart failure symptoms in whom echocardiography is inconclusive or suggests a DCM and in whom further diagnostic clarification is required; what is the safety, effectiveness and cost-effectiveness of CMRI compared to invasive coronary angiography, SPECT, CTCA or watchful waiting in the context of optimal medical therapy?Population TwoPopulation Two includes two subgroups of patients with suspected hypertrophic or restrictive cardiomyopathies:Patients in whom echocardiography suggests increased wall thickness, a hypertrophic or restrictive cardiomyopathy is suspected, and in whom further diagnostic clarification is required.Asymptomatic patients with a family history of hypertrophic or restrictive cardiomyopathy in a first-degree relative.Clinical claim for the proposed interventionIncreased LV wall thickness may be physiological (in response to pressure loading such as hypertension or aortic stenosis) or pathological (such as abnormal LV hypertrophy or myocardial infiltration). Hypertrophic and restrictive cardiomyopathies have been combined in Population 2 due to difficulty in differentiating between these two phenotypes of cardiomyopathy by echo and clinical assessment. In patients with suspected HCM or RCM, CMRI provides information regarding the patient’s left ventricular morphology and tissue characterisation. This information can help differentiate physiological hypertrophy from pathologically increased LV wall thickness. It may also help differentiate infiltration from HCM and may provide further information on the type of infiltration. This may have an impact on patient management and the need for the investigation of first degree relatives. CMRI can identify myocardial scarring, which is a contributory risk factor for sudden cardiac arrest, and can allow for more appropriate use of an ICD with suspected HCM. CMRI is capable of identifying regions of LV hypertrophy not readily recognised by echocardiography and can be solely responsible for diagnosis of the HCM phenotype in an important minority of patients.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaWNrZXJzPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaWNrZXJzPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE.DATA 49, 65 Due to improved visualisation of the myocardium when compared to echocardiogram, CMRI can identify otherwise undetected areas of wall thickening in the anterolateral LV free wall resulting in a diagnosis of HCM that could otherwise be missed. In this regard, the Applicant suggests that CMRI be recommended even if the echocardiography result is negative, in the context of a positive family history. This principle is also important when testing family members suspected of having HCM.There are benefits of CMRI in terms of diagnostic accuracy compared to comparators such as echocardiography, as specified in section 4C. In summary, the proposed benefits of CMRI in patients with suspected HCM or RCM include:Increased ability to differentiate between HCM and RCM, due to increased diagnostic sensitivity compared to the current non-invasive techniques of investigating RCM.Potential change in patient management due to increased diagnostic sensitivity, leading to a change in diagnosis and treatment parator(s)In Australian clinical practice, in the absence of CMRI a diagnosis of HCM or RCM is most commonly established through watchful waiting in combination with conventional therapy.Reference standard(s)The current reference standard for RCM is right ventricular biopsy,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KZXNzdXA8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KZXNzdXA8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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 EN.CITE.DATA 66 however, as noted previously, this technique is seldom used in clinical practice due to its invasiveness and risk of sampling error.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EaWNrZXJzb248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EaWNrZXJzb248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy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=
ADDIN EN.CITE.DATA 38 The reference standards for HCM are myocardial biopsy or genetic testing, depending on the aetiology of the condition.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJzaDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJzaDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE.DATA 21 Both of these tests are considered to be imperfect reference standards.Clinical pathwayThe diagnosis of HCM is often established on the basis of family history, clinical assessment, biochemistry and non-invasive testing (including clinical assessment, ECG, echocardiography and CMRI).PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FbGxpb3R0PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FbGxpb3R0PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48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ADDIN EN.CITE.DATA 67 The primary use of CMRI in population Two is as an adjunct diagnostic tool in conjunction with echocardiography, ECG and clinical examination. Device therapy (i.e. ICD) is the most important therapy for these patients, rather than medical treatment. The clinical pathway for suspected HCM/RCM ( REF _Ref411411635 \h \* MERGEFORMAT Figure 3) has been informed by the European Society of Cardiology’s clinical practice guidelines for the diagnosis and treatment of hypertrophic cardiomyopathy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJzaDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJzaDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE.DATA 21 Figure SEQ Figure \* ARABIC 3: Proposed clinical practice algorithm for the diagnosis of suspected HCM/RCMECG=electrocardiography, HCM=hypertrophic cardiomyopathy, ICD=implantable cardioverter defibrillator, LV=left ventricle, MRI=magnetic resonance imaging, OMT=optimal medical therapy, RCM=restrictive cardiomyopathy.In asymptomatic patients with a family history of HCM or RCM, CMRI is primarily intended to be used as an adjunct to conventional testing (including clinical assessment, ECG and echocardiography). In patients with a suspected pathology based on conventional testing, CMRI will provide additional information on the aetiology of the disease, leading to potential changes to therapeutic management. In the absence of CMRI, patients are typically managed with follow-up monitoring. The clinical pathway for the investigation of patients with a family history of HCM/RCM in a first degree relative is presented in Figure 4.Figure SEQ Figure \* ARABIC 4: Proposed clinical practice algorithm for the investigation of asymptomatic patients with a family history of HCM/RCM in a first-degree relativeECG=electrocardiography, HCM=hypertrophic cardiomyopathy, ICD=implantable cardioverter defibrillator, LV=left ventricle, MRI=magnetic resonance imaging, OMT=optimal medical therapy, RCM=restrictive cardiomyopathy.Relevant health outcomes for the investigation of CMRI in patients with suspected HCM/RCM are outlined in Table 3.Economic evaluationThe economic evaluation for the proposed service is informed by the following clinical claims:Superior safety and non-inferior effectiveness compared to myocardial biopsyNon-inferior safety and superior effectiveness compared to genetic testing Non-inferior safety and superior effectiveness compared to non-invasive testingIn this context, the economic evaluation of the proposed service will be a cost-effectiveness analysis/cost-utility analysis.Summary of PICO criteriaTable SEQ Table \* ARABIC 3: Summary of PICO to define the research question(s) for Population TwoPICO CriteriaCommentsPatientsPatients in whom echocardiography suggests increased wall thickness, a hypertrophic or restrictive cardiomyopathy is suspected, and in whom further diagnostic clarification is required.Asymptomatic patients with a family history of hypertrophic or restrictive cardiomyopathy in a first-degree relative.InterventionMRI assessment of myocardial structure and function, including tissue characterisationComparatorWatchful waiting in the context of conventional therapyOutcomesSafetyGadolinium contrast adverse reactionClaustrophobiaPhysical harms from follow-up testingHarms associated with the investigation of first degree relativesOther adverse events arising from CMRIEffectivenessHealth outcomesCardiac disease-specific mortalitySurvivalCardiac hospitalisationAdverse cardiac event over defined periodQuality of life scoresDiagnostic accuracySensitivity, specificity (confirmed by reference standard)Positive predictive value, negative predictive value (confirmed by reference standard)Positive likelihood ratio, negative likelihood ratio (confirmed by reference standard)ROC curvesUnsatisfactory or uninterpretable test resultsPatient managementChange in clinical diagnosisChange in treatment pathway (initiated, ceased, modified, avoided)Patient compliance with, preference for imagingTime to initial diagnosisTime from diagnosis to treatmentRates of re-interventionCost-effectivenessCostCost per quality adjusted life year or disability adjusted life yearIncremental cost-effectiveness ratioPrior testsClinical examinationEchocardiography (MBS Items 55113, 55115, 55118)ECG (MBS Items 11700, 11701, 11702)Reference standard(s)Myocardial biopsy (MBS Item 38275) and genetic testing (MBS Item 73317 for hemochromatosis, no other items identified).Research question for assessment: In asymptomatic patients with a family history of HCM or RCM, or in patients in whom echocardiography suggests increased LV wall thickness, a HCM or RCM is suspected, and in whom further diagnostic clarification is required; what is the safety, effectiveness and cost-effectiveness of CMRI compared to watchful waiting in the context of conventional therapy.Population ThreePopulation Three includes two subgroups of patients with suspected arrhythmogenic right ventricular cardiomyopathy:Patients in whom arrhythmogenic right ventricular cardiomyopathy is suspected on the basis of other International Task Force Criteria.Asymptomatic patients with a family history of arrhythmogenic right ventricular cardiomyopathy in a first-degree relative.Clinical claim for the proposed interventionThe primary use of CMRI in Population Three is as an adjunct diagnostic tool in conjunction with a number of tests outlined in the International Task Force Criteria for diagnosing ARVC.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 23 In accordance with the Criteria, prior non-invasive tests may include ECG (including Holter monitoring, resting ECG, or signal-averaged ECG) or echocardiography. International guidelines state that MRI is an accepted part of the assessment of patients with suspected ARVC, and is not intended to replace other tests. CMRI can contribute both major and minor criteria towards the diagnosis of ARVC. Beyond RV dilation, CMRI adds regional RV akinesia, dyskinesia, or aneurysm.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS
ZWNOdW0+Mzk8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4y
Mzwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjM5PC9yZWMtbnVtYmVy
Pjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icjV6enY5OTluejJzZG5ldnp6enZm
ZDBpeDB2enR6ZmR4MHNyIiB0aW1lc3RhbXA9IjE0MTI4OTkyMzgiPjM5PC9rZXk+PC9mb3JlaWdu
LWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250
cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5NYXJjdXMsIEYuIEkuPC9hdXRob3I+PGF1dGhvcj5N
Y0tlbm5hLCBXLiBKLjwvYXV0aG9yPjxhdXRob3I+U2hlcnJpbGwsIEQuPC9hdXRob3I+PGF1dGhv
cj5CYXNzbywgQy48L2F1dGhvcj48YXV0aG9yPkJhdWNlLCBCLjwvYXV0aG9yPjxhdXRob3I+Qmx1
ZW1rZSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkNhbGtpbnMsIEguPC9hdXRob3I+PGF1dGhvcj5D
b3JyYWRvLCBELjwvYXV0aG9yPjxhdXRob3I+Q294LCBNLiBHLjwvYXV0aG9yPjxhdXRob3I+RGF1
YmVydCwgSi4gUC48L2F1dGhvcj48YXV0aG9yPkZvbnRhaW5lLCBHLjwvYXV0aG9yPjxhdXRob3I+
R2VhciwgSy48L2F1dGhvcj48YXV0aG9yPkhhdWVyLCBSLjwvYXV0aG9yPjxhdXRob3I+TmF2YSwg
QS48L2F1dGhvcj48YXV0aG9yPlBpY2FyZCwgTS4gSC48L2F1dGhvcj48YXV0aG9yPlByb3Rvbm90
YXJpb3MsIE4uPC9hdXRob3I+PGF1dGhvcj5TYWZmaXR6LCBKLiBFLjwvYXV0aG9yPjxhdXRob3I+
U2FuYm9ybiwgRC4gTS48L2F1dGhvcj48YXV0aG9yPlN0ZWluYmVyZywgSi4gUy48L2F1dGhvcj48
YXV0aG9yPlRhbmRyaSwgSC48L2F1dGhvcj48YXV0aG9yPlRoaWVuZSwgRy48L2F1dGhvcj48YXV0
aG9yPlRvd2JpbiwgSi4gQS48L2F1dGhvcj48YXV0aG9yPlRzYXRzb3BvdWxvdSwgQS48L2F1dGhv
cj48YXV0aG9yPldpY2h0ZXIsIFQuPC9hdXRob3I+PGF1dGhvcj5aYXJlYmEsIFcuPC9hdXRob3I+
PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+VW5pdmVyc2l0eSBvZiBBcml6
b25hLCBUdWNzb24sIEFaLCBVU0EuIGZtYXJjdXNAdS5hcml6b25hLmVkdTwvYXV0aC1hZGRyZXNz
Pjx0aXRsZXM+PHRpdGxlPkRpYWdub3NpcyBvZiBhcnJoeXRobW9nZW5pYyByaWdodCB2ZW50cmlj
dWxhciBjYXJkaW9teW9wYXRoeS9keXNwbGFzaWE6IHByb3Bvc2VkIG1vZGlmaWNhdGlvbiBvZiB0
aGUgVGFzayBGb3JjZSBDcml0ZXJpYTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5FdXIgSGVhcnQg
Sjwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+RXVyb3BlYW4gaGVhcnQgam91cm5hbDwvYWx0
LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkV1ciBIZWFydCBKPC9mdWxs
LXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+ODA2LTE0PC9wYWdlcz48dm9sdW1lPjMxPC92b2x1
bWU+PG51bWJlcj43PC9udW1iZXI+PGVkaXRpb24+MjAxMC8wMi8yMzwvZWRpdGlvbj48a2V5d29y
ZHM+PGtleXdvcmQ+QXJyaHl0aG1vZ2VuaWMgUmlnaHQgVmVudHJpY3VsYXIgRHlzcGxhc2lhLypk
aWFnbm9zaXMvZ2VuZXRpY3MvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5CaW9wc3k8L2tleXdv
cmQ+PGtleXdvcmQ+RWxlY3Ryb2NhcmRpb2dyYXBoeTwva2V5d29yZD48a2V5d29yZD5HZW5vdHlw
ZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFnbmV0aWMgUmVz
b25hbmNlIEFuZ2lvZ3JhcGh5L3N0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5NeW9jYXJkaXVt
L3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5QaGVub3R5cGU8L2tleXdvcmQ+PGtleXdvcmQ+
UHJhY3RpY2UgR3VpZGVsaW5lcyBhcyBUb3BpYzwva2V5d29yZD48a2V5d29yZD5TZW5zaXRpdml0
eSBhbmQgU3BlY2lmaWNpdHk8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMDwv
eWVhcj48cHViLWRhdGVzPjxkYXRlPkFwcjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2Ju
PjAxOTUtNjY4eDwvaXNibj48YWNjZXNzaW9uLW51bT4yMDE3MjkxMjwvYWNjZXNzaW9uLW51bT48
dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3BtYy9h
cnRpY2xlcy9QTUMyODQ4MzI2L3BkZi9laHEwMjUucGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91
cmxzPjxjdXN0b20yPlBtYzI4NDgzMjY8L2N1c3RvbTI+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt
PjEwLjEwOTMvZXVyaGVhcnRqL2VocTAyNTwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90
ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3Vh
Z2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 23 These abnormalities are often not revealed adequately by echocardiography. A study by Borgquist et al (2014) indicates that up to 50% of patients with ARVD would have been missed had they been assessed only by echocardiography and if CMRI was not utilised.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Cb3JncXVpc3Q8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Cb3JncXVpc3Q8L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy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ADDIN EN.CITE.DATA 54 The diagnosis of ARVC can be made based on either two major, or one major and two minor criteria, or four minor criteria from different categories. Thus, the use of MRI may avoid the need for invasive testing, such as myocardial biopsy, RV angiography or electrophysiological studies if enough diagnostic criteria can be established with non-invasive imaging tests. ADDIN EN.CITE <EndNote><Cite><Author>Anderson</Author><Year>2006</Year><RecNum>189</RecNum><DisplayText><style face="superscript">68</style></DisplayText><record><rec-number>189</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413759232">189</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Anderson, E. L.</author></authors></contributors><auth-address>Naval Air Station Jacksonville, Florida, USA. NavyFamilyDoctor@</auth-address><titles><title>Arrhythmogenic right ventricular dysplasia</title><secondary-title>Am Fam Physician</secondary-title><alt-title>American family physician</alt-title></titles><periodical><full-title>Am Fam Physician</full-title><abbr-1>American family physician</abbr-1></periodical><alt-periodical><full-title>Am Fam Physician</full-title><abbr-1>American family physician</abbr-1></alt-periodical><pages>1391-8</pages><volume>73</volume><number>8</number><edition>2006/05/04</edition><keywords><keyword>Algorithms</keyword><keyword>*Arrhythmogenic Right Ventricular</keyword><keyword>Dysplasia/complications/diagnosis/physiopathology/therapy</keyword><keyword>Death, Sudden, Cardiac/etiology</keyword><keyword>Diagnosis, Differential</keyword><keyword>Humans</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2006</year><pub-dates><date>Apr 15</date></pub-dates></dates><isbn>0002-838X (Print)
0002-838x</isbn><accession-num>16669561</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>68There are benefits of CMRI in terms of diagnostic accuracy compared to comparators particularly with an increase in diagnostic information leading to an alternate diagnosis. In the study by Liu et al (2014) CMRI was performed upon 968 patients with suspected ARVC. ADDIN EN.CITE <EndNote><Cite><Author>Liu</Author><Year>2014</Year><RecNum>226</RecNum><DisplayText><style face="superscript">69</style></DisplayText><record><rec-number>226</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1424236270">226</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Liu, T.</author><author>Pursnani, A.</author><author>Sharma, U. C.</author><author>Vorasettakarnkij, Y.</author><author>Verdini, D.</author><author>Deeprasertkul, P.</author><author>Lee, A. M.</author><author>Lumish, H.</author><author>Sidhu, M. S.</author><author>Medina, H.</author><author>Danik, S.</author><author>Abbara, S.</author><author>Holmvang, G.</author><author>Hoffmann, U.</author><author>Ghoshhajra, B. B.</author></authors></contributors><auth-address>Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China. tingliu365@.</auth-address><titles><title>Effect of the 2010 task force criteria on reclassification of cardiovascular magnetic resonance criteria for arrhythmogenic right ventricular cardiomyopathy</title><secondary-title>J Cardiovasc Magn Reson</secondary-title><alt-title>Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance</alt-title></titles><periodical><full-title>J Cardiovasc Magn Reson</full-title></periodical><pages>47</pages><volume>16</volume><edition>2014/07/06</edition><dates><year>2014</year></dates><isbn>1097-6647</isbn><accession-num>24996808</accession-num><urls></urls><custom2>Pmc4105392</custom2><electronic-resource-num>10.1186/1532-429x-16-47</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>69 CMRI identified alternative cardiac diagnoses in 9.2% of patients, and in 43 patients (4.4%) of the diagnoses were clinically significant mimics of ARVC, including cardiac sarcoidosis, congenital heart disease, right ventricular (RV) volume overload conditions, and other cardiomyopathies. Similarly a New Zealand study by Looi et al (2012) of 92 patients with suspected ARVC found that CMRI detected important, previously undiagnosed pathology, including partial anomalous pulmonary venous drainage (2%) and dilated left ventricle (3%), left ventricular dysfunction (6%) and other minor abnormalities (5%). ADDIN EN.CITE <EndNote><Cite><Author>Looi</Author><Year>2012</Year><RecNum>227</RecNum><DisplayText><style face="superscript">70</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1424236350">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Looi, K. L.</author><author>Edwards, C.</author><author>Hart, H.</author><author>Christiansen, J. P.</author></authors></contributors><auth-address>Cardiovascular Division, North Shore Hospital, Waitemata Health.</auth-address><titles><title>Utility of cardiac magnetic resonance in the evaluation of unselected patients with possible arrhythmogenic right ventricular cardiomyopathy</title><secondary-title>Clin Med Insights Cardiol</secondary-title><alt-title>Clinical Medicine Insights. Cardiology</alt-title></titles><periodical><full-title>Clin Med Insights Cardiol</full-title><abbr-1>Clinical Medicine Insights. Cardiology</abbr-1></periodical><alt-periodical><full-title>Clin Med Insights Cardiol</full-title><abbr-1>Clinical Medicine Insights. Cardiology</abbr-1></alt-periodical><pages>153-62</pages><volume>6</volume><edition>2012/12/12</edition><keywords><keyword>cardiac magnetic resonance imaging</keyword><keyword>cardiomyopathy</keyword></keywords><dates><year>2012</year></dates><accession-num>23226076</accession-num><urls></urls><custom2>Pmc3511051</custom2><electronic-resource-num>10.4137/cmc.s9996</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>70 No patients had ARVC based upon the 1994 Task Force Criteria (TFC) prior to CMRI, but four met proposed Modified TFC. The CMRI scans revealed nine patients (10%) who had findings consistent with ARVC. Two patients met one major TFC whereas seven met one or two minor criteria. ADDIN EN.CITE <EndNote><Cite><Author>Looi</Author><Year>2012</Year><RecNum>227</RecNum><DisplayText><style face="superscript">70</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1424236350">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Looi, K. L.</author><author>Edwards, C.</author><author>Hart, H.</author><author>Christiansen, J. P.</author></authors></contributors><auth-address>Cardiovascular Division, North Shore Hospital, Waitemata Health.</auth-address><titles><title>Utility of cardiac magnetic resonance in the evaluation of unselected patients with possible arrhythmogenic right ventricular cardiomyopathy</title><secondary-title>Clin Med Insights Cardiol</secondary-title><alt-title>Clinical Medicine Insights. Cardiology</alt-title></titles><periodical><full-title>Clin Med Insights Cardiol</full-title><abbr-1>Clinical Medicine Insights. Cardiology</abbr-1></periodical><alt-periodical><full-title>Clin Med Insights Cardiol</full-title><abbr-1>Clinical Medicine Insights. Cardiology</abbr-1></alt-periodical><pages>153-62</pages><volume>6</volume><edition>2012/12/12</edition><keywords><keyword>cardiac magnetic resonance imaging</keyword><keyword>cardiomyopathy</keyword></keywords><dates><year>2012</year></dates><accession-num>23226076</accession-num><urls></urls><custom2>Pmc3511051</custom2><electronic-resource-num>10.4137/cmc.s9996</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>70 In terms of any potential change in patient management, when compared to comparators or no MRI, this evidence would suggest that approximately 10% of these patients would have a new cardiac diagnosis that ought to lead to a change in their therapy. The benefits of the change in management to patient health outcomes are in two groups; those patients in whom the MRI makes the diagnosis of ARVC when other criteria have been inconclusive and those in whom the MRI identifies another diagnosis. Specific examples of the latter would include those with sarcoid, who could receive immunosuppression and avoid progressive cardiac disease, those with congenital heart disease who could undergo corrective surgery, those with amyloid from a treatable condition (such as myeloma) who could undergo therapy, etc.An estimate for the size of the effect of these claims (supported by references above) would be as follows:10% to 50% of ARVC patients, who would otherwise have been missed, would be diagnosed with ARVC following CMRI. Due to the high risk of sudden arrhythmic death in this condition some would be eligible for ICD implantation that should abort sudden death in most cases. The identification of these patients could also lead to appropriate screening of family members and avoidance of sudden death in these relatives too. 10% of patients with significant alternate cardiac diagnosis would be identified. In those with congenital heart disease (at least 2%) corrective surgery could be performed. This may avoid ICD implantation but more importantly will avoid progressive right heart failure and premature death. Their relatives would not need any investigations for ARVC.The primary benefits of CMRI for Population Three therefore include:Increased safety compared to existing invasive diagnostic testing options.Potential avoidance of invasive diagnostic testing (including myocardial biopsy, angiography and electrophysiologic studies) due to earlier establishment of required criteria to confirm a diagnosis of ARVC.Improved diagnostic sensitivity and specificity for identifying International Task Force parator(s)As MRI is intended to be used as an adjunct to existing diagnostic imaging modalities, the appropriate comparator to MRI for Population Three is watchful waiting in the context of optimal medical therapy.Reference standard(s)There is currently no single test that represents the reference standard for diagnosing ARVC. A diagnosis of ARVC is confirmed based on International Task Force Criteria, and is defined by the presence of either:Two major criteria; orOne major and two minor criteria; orFour minor criteria.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 23Clinical pathwayCMRI is an established tool used in the workup for establishing a diagnosis of ARVC. The clinical management algorithm for the evaluation of patients with suspected ARVC is informed by the International Task Force Criteria,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJjdXM8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS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ADDIN EN.CITE.DATA 23 and a published diagnostic algorithm by Anderson (2006). ADDIN EN.CITE <EndNote><Cite><Author>Anderson</Author><Year>2006</Year><RecNum>189</RecNum><DisplayText><style face="superscript">68</style></DisplayText><record><rec-number>189</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413759232">189</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Anderson, E. L.</author></authors></contributors><auth-address>Naval Air Station Jacksonville, Florida, USA. NavyFamilyDoctor@</auth-address><titles><title>Arrhythmogenic right ventricular dysplasia</title><secondary-title>Am Fam Physician</secondary-title><alt-title>American family physician</alt-title></titles><periodical><full-title>Am Fam Physician</full-title><abbr-1>American family physician</abbr-1></periodical><alt-periodical><full-title>Am Fam Physician</full-title><abbr-1>American family physician</abbr-1></alt-periodical><pages>1391-8</pages><volume>73</volume><number>8</number><edition>2006/05/04</edition><keywords><keyword>Algorithms</keyword><keyword>*Arrhythmogenic Right Ventricular</keyword><keyword>Dysplasia/complications/diagnosis/physiopathology/therapy</keyword><keyword>Death, Sudden, Cardiac/etiology</keyword><keyword>Diagnosis, Differential</keyword><keyword>Humans</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2006</year><pub-dates><date>Apr 15</date></pub-dates></dates><isbn>0002-838X (Print)
0002-838x</isbn><accession-num>16669561</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>68 The primary difference between the clinical pathways for symptomatic (Figure 5) and asymptomatic patients (Figure 6) is the decision to proceed to either follow-up monitoring or further diagnostic testing if ARVC is not suspected following non-invasive testing. Figure SEQ Figure \* ARABIC 5:Proposed clinical practice algorithm for the diagnosis of suspected ARVCARVC=arrhythmogenic right ventricular cardiomyopathy, ECG=electrocardiography, ICD=implantable cardioverter defibrillator, MRI=magnetic resonance imaging, OMT=optimal medical therapy, RV=right ventricle.Figure SEQ Figure \* ARABIC 6:Proposed clinical practice algorithm for investigating patients with a family history of ARVC in a first degree relativeARVC=arrhythmogenic right ventricular cardiomyopathy, ECG=electrocardiography, ICD=implantable cardioverter defibrillator, MRI=magnetic resonance imaging, OMT=optimal medical therapy, RV=right ventricle.Health outcomesRelevant health outcomes for the investigation of CMRI in patients with suspected ARVC are outlined in Table 4.Economic evaluationThe economic evaluation for the proposed service is informed by the following clinical claims:Non-inferior safety and superior effectiveness compared to non-invasive testing. Superior safety and non-inferior effectiveness compared to invasive testing.In this context, the economic evaluation of the proposed service will be a cost-effectiveness analysis/cost-utility analysis.Summary of PICO criteriaTable SEQ Table \* ARABIC 4: Summary of PICO to define the research question(s) for Population ThreePICO CriteriaCommentsPatientsPatients in whom arrhythmogenic right ventricular cardiomyopathy is suspected on the basis of other International Task Force CriteriaInterventionMRI assessment of myocardial structure and function ComparatorWatchful waiting with optimal medical therapyOutcomesSafetyGadolinium contrast adverse reactionClaustrophobiaPhysical harms from follow-up testingHarms associated with the investigation of asymptomatic individuals with a family history of ARVCOther adverse events arising from CMRIEffectivenessHealth outcomesCardiac disease-specific mortalitySurvivalCardiac hospitalisationAdverse cardiac event over defined periodQuality of life scoresDiagnostic accuracySensitivity, specificity (confirmed by reference standard)Positive predictive value, negative predictive value (confirmed by reference standard)Positive likelihood ratio, negative likelihood ratio (confirmed by reference standard)ROC curvesUnsatisfactory or uninterpretable test resultsPatient managementChange in clinical diagnosisChange in treatment pathway (initiated, ceased, modified, avoided)Patient compliance with, preference for imagingTime to initial diagnosisTime from diagnosis to treatmentRates of re-interventionCost-effectivenessCostCost per quality adjusted life year or disability adjusted life yearIncremental cost-effectiveness ratioPrior test(s)Clinical examination Transthoracic echocardiography (MBS Items 55113, 55115)Holter monitoring (MBS Item 11709)Signal-averaged ECG (MBS Item 11713) Exercise stress testing (MBS Item 11712)Reference standard(s)International Task Force CriteriaResearch question for assessment: In patients with a family history of ARVC, or in whom ARVC is suspected on the basis of other International Task Force Criteria, what is the safety, effectiveness and cost-effectiveness of CMRI compared to watchful waiting in the context of optimal medical therapy?Population FourPopulation Four includes patients with troponin-positive chest pain, ECG changes suspicious of acute coronary syndrome (ACS), and no culprit lesion identified on coronary angiography.Clinical claim for the proposed interventionIdentifying the underlying aetiology in troponin-positive patients who do not have ACS is important for ensuring that treatment pathways are appropriate. Establishing an alternate diagnosis with CMRI can spare patients lifelong medical therapy for the secondary prevention of CAD, and spare multiple further investigations such as transoesophageal echocardiography to identify a paradoxical embolism. Without MRI, the default diagnosis will often be ACS secondary to CAD, even though non-obstructive or normal coronary arteries have been reported in up to 10% of ST-elevation myocardial infarction and 12% of non-ST elevation myocardial infarction.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2U8L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2U8L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA 71, 72 Such patients would undergo needless life-long medical therapy and follow-up for CAD. In contrast, patients with myocarditis often will need only follow-up investigation to determine the aetiology of the myocardial inflammation, and medication for a short period.The benefits of MRI in this population include:Increased sensitivity and specificity for correctly identifying the underlying aetiology of symptoms compared to watchful waiting.Change in patient management compared to watchful waiting, which in certain patients will lead to avoidance of unnecessary treatment and follow-up parator(s)In Population Four, CMRI will potentially replace watchful waiting in the context of optimal medical therapy. The Applicant suggests that in current clinical practice patients suspected of having an acute coronary event, but in whom no culprit lesion is identified, may proceed to medical therapy without further investigation. These patients may receive a lifetime of unnecessary, PBS-sponsored medication if the underlying diagnosis is not CAD (i.e. is acute myocarditis or takutsubo/stress cardiomyopathy). Furthermore, an incorrect diagnosis of ACS in this situation may also impact adversely on the patient in terms of future employment and/or insurance.Reference standard(s)There is currently no definitive reference standard for confirming a diagnosis of takotsubo cardiomyopathy. In the absence of a suitable reference test, clinical follow-up provides the best confirmation of a diagnosis of takotsubo cardiomyopathy. The reference standard for diagnosing myocarditis is myocardial biopsy. ADDIN EN.CITE <EndNote><Cite><Author>Aretz</Author><Year>1987</Year><RecNum>188</RecNum><DisplayText><style face="superscript">73</style></DisplayText><record><rec-number>188</rec-number><foreign-keys><key app="EN" db-id="r5zzv999nz2sdnevzzzvfd0ix0vztzfdx0sr" timestamp="1413732464">188</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Aretz, H. T.</author><author>Billingham, M. E.</author><author>Edwards, W. D.</author><author>Factor, S. M.</author><author>Fallon, J. T.</author><author>Fenoglio, J. J., Jr.</author><author>Olsen, E. G.</author><author>Schoen, F. J.</author></authors></contributors><auth-address>Department of Pathology, Lahey Clinic Medical Center, Burlington, Massachusetts.</auth-address><titles><title>Myocarditis. A histopathologic definition and classification</title><secondary-title>Am J Cardiovasc Pathol</secondary-title><alt-title>Am J Cardiovasc Pathol</alt-title></titles><periodical><full-title>Am J Cardiovasc Pathol</full-title><abbr-1>The American journal of cardiovascular pathology</abbr-1></periodical><alt-periodical><full-title>Am J Cardiovasc Pathol</full-title><abbr-1>The American journal of cardiovascular pathology</abbr-1></alt-periodical><pages>3-14</pages><volume>1</volume><number>1</number><edition>1987/01/01</edition><keywords><keyword>Biopsy</keyword><keyword>Cardiomyopathy, Dilated/diagnosis</keyword><keyword>Diagnosis, Differential</keyword><keyword>Humans</keyword><keyword>Myocarditis/classification/diagnosis/*pathology</keyword><keyword>Myocardium/*pathology</keyword></keywords><dates><year>1987</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0887-8005 (Print)
0887-8005</isbn><accession-num>3455232</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>73 However, as noted previously, this technique is seldom used in clinical practice due to its invasiveness and risk of sampling error. As with the other populations, CMRI can identify alternate diagnoses including HCM or infiltrative cardiomyopathy who would otherwise be missed. The study by Assomull et al (2007) suggests that a cardiomyopathy would be identified in ~4% of patients, a myocardial infarct would be the diagnosis in 12% and 50% of patients would have myocarditis.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+
PFJlY051bT4yMjg8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0
Ij43NDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIyODwvcmVjLW51
bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InI1enp2OTk5bnoyc2RuZXZ6
enp2ZmQwaXgwdnp0emZkeDBzciIgdGltZXN0YW1wPSIxNDI0MjM2ODcyIj4yMjg8L2tleT48L2Zv
cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+
PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkFzc29tdWxsLCBSLiBHLjwvYXV0aG9yPjxh
dXRob3I+THluZSwgSi4gQy48L2F1dGhvcj48YXV0aG9yPktlZW5hbiwgTi48L2F1dGhvcj48YXV0
aG9yPkd1bGF0aSwgQS48L2F1dGhvcj48YXV0aG9yPkJ1bmNlLCBOLiBILjwvYXV0aG9yPjxhdXRo
b3I+RGF2aWVzLCBTLiBXLjwvYXV0aG9yPjxhdXRob3I+UGVubmVsbCwgRC4gSi48L2F1dGhvcj48
YXV0aG9yPlByYXNhZCwgUy4gSy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1
dGgtYWRkcmVzcz5DYXJkaW92YXNjdWxhciBNYWduZXRpYyBSZXNvbmFuY2UgVW5pdCwgUm95YWwg
QnJvbXB0b24gSG9zcGl0YWwsIExvbmRvbiBTVzMgNk5QLCBVSy48L2F1dGgtYWRkcmVzcz48dGl0
bGVzPjx0aXRsZT5UaGUgcm9sZSBvZiBjYXJkaW92YXNjdWxhciBtYWduZXRpYyByZXNvbmFuY2Ug
aW4gcGF0aWVudHMgcHJlc2VudGluZyB3aXRoIGNoZXN0IHBhaW4sIHJhaXNlZCB0cm9wb25pbiwg
YW5kIHVub2JzdHJ1Y3RlZCBjb3JvbmFyeSBhcnRlcmllczwvdGl0bGU+PHNlY29uZGFyeS10aXRs
ZT5FdXIgSGVhcnQgSjwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+RXVyb3BlYW4gaGVhcnQg
am91cm5hbDwvYWx0LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkV1ciBI
ZWFydCBKPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MTI0Mi05PC9wYWdlcz48dm9s
dW1lPjI4PC92b2x1bWU+PG51bWJlcj4xMDwvbnVtYmVyPjxlZGl0aW9uPjIwMDcvMDUvMDU8L2Vk
aXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkJpb2xvZ2lj
YWwgTWFya2Vycy9ibG9vZDwva2V5d29yZD48a2V5d29yZD5DYXJkaW9teW9wYXRoeSwgRGlsYXRl
ZC9jb21wbGljYXRpb25zL2RpYWdub3Npczwva2V5d29yZD48a2V5d29yZD5DaGVzdCBQYWluLypl
dGlvbG9neTwva2V5d29yZD48a2V5d29yZD5Db250cmFzdCBNZWRpYTwva2V5d29yZD48a2V5d29y
ZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2Fkb2xpbml1bSBEVFBBL2RpYWdub3N0aWMgdXNl
PC9rZXl3b3JkPjxrZXl3b3JkPkhlYXJ0IERpc2Vhc2VzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Np
czwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SW1hZ2UgRW5oYW5j
ZW1lbnQvbWV0aG9kczwva2V5d29yZD48a2V5d29yZD5Mb25kb248L2tleXdvcmQ+PGtleXdvcmQ+
TWFnbmV0aWMgUmVzb25hbmNlIEltYWdpbmcsIENpbmUvbWV0aG9kczwva2V5d29yZD48a2V5d29y
ZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPk15
b2NhcmRpYWwgSW5mYXJjdGlvbi9jb21wbGljYXRpb25zPC9rZXl3b3JkPjxrZXl3b3JkPk15b2Nh
cmRpdGlzL2NvbXBsaWNhdGlvbnMvZGlhZ25vc2lzPC9rZXl3b3JkPjxrZXl3b3JkPlByb3NwZWN0
aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+VGFrb3RzdWJvIENhcmRpb215b3BhdGh5L2Nv
bXBsaWNhdGlvbnMvZGlhZ25vc2lzPC9rZXl3b3JkPjxrZXl3b3JkPlRyb3BvbmluL2Jsb29kPC9r
ZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMDc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0
ZT5NYXk8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMTk1LTY2OFggKFByaW50KSYj
eEQ7MDE5NS02Njh4PC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE3NDc4NDU4PC9hY2Nlc3Npb24tbnVt
Pjx1cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA5My9ldXJoZWFydGov
ZWhtMTEzPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVy
Pk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwv
cmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc3NvbXVsbDwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+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ADDIN EN.CITE.DATA 74 In 35% the MRI was inconclusive. The change in management therefore depends upon the presumptive diagnosis prior to MRI. If it is assumed that all these patients are treated as an ACS (NSTEMI) then MRI would change management in more than 50% of patients. The majority would not require lifelong statin therapy, ACE inhibitor therapy, aspirin therapy or 12 months of clopidogrel. If the presumptive diagnosis was myocarditis then the diagnosis would be changed in 15% so that appropriate therapy could be delivered. Considering the ACS subgroup, this could reduce recurrent presentation and ischaemic events by more than 40%.Clinical pathwayThe primary use of CMRI in Population Four is as an adjunct diagnostic tool in conjunction with ECG, biochemistry, angiography and echocardiography. In these patients the diagnosis is often unclear, but primarily includes CAD, acute myocarditis or takotsubo cardiomyopathy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJiYXVkPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HZXJiYXVkPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48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ADDIN EN.CITE.DATA 55 The current clinical management pathway was established by the Assessment Group in consultation with the Applicant.Figure SEQ Figure \* ARABIC 7: Proposed clinical practice algorithm for the diagnosis of patients with troponin-positive chest pain, ECG changes suspicious of ACS, and no culprit lesion identified on angiogram.CAD=coronary artery disease, CTCA=computed tomography coronary angiography, ECG=electrocardiography, ICD=implantable cardioverter defibrillator, LV=left ventricular, MRI=magnetic resonance imaging, OMT=optimal medical therapy.Health outcomesRelevant health outcomes for the investigation of CMRI in patients with troponin-positive chest pain, ECG changes suspicious of ACS, and no culprit lesion identified on angiogram are outlined in Table 5.Economic evaluationThe economic evaluation for the proposed service is informed by the following clinical claims:Non-inferior safety and superior effectiveness compared to echocardiography.Non-inferior safety and superior effectiveness compared to directed medical therapy without further testing.Superior safety and superior effectiveness compared to myocardial biopsy.In this context, the economic evaluation of the proposed service will be a cost-effectiveness analysis/cost-utility analysis.Summary of PICO criteriaTable SEQ Table \* ARABIC 5: Summary of PICO to define the research question(s) for Population FourPICO CriteriaCommentsPatientsPatients with troponin-positive chest pain, ECG changes suspicious of ACS, and no culprit lesion identified on coronary angiography.InterventionMRI assessment of myocardial structure and function, including tissue characterisationComparatorWatchful waiting in the context of optimal medical therapyOutcomesSafetyGadolinium contrast adverse reactionClaustrophobiaPhysical harms from follow-up testingOther adverse events arising from CMRIEffectivenessHealth outcomesCardiac disease-specific mortalitySurvivalCardiac hospitalisationAdverse cardiac event over defined periodQuality of life scoresDiagnostic accuracySensitivity, specificity (confirmed by reference standard)Positive predictive value, negative predictive value (confirmed by reference standard)Positive likelihood ratio, negative likelihood ratio (confirmed by reference standard)ROC curvesUnsatisfactory or uninterpretable test resultsPatient managementChange in clinical diagnosisChange in treatment pathway (initiated, ceased, modified, avoided)Patient compliance with, preference for imagingTime to initial diagnosisTime from diagnosis to treatmentRates of re-interventionCost-effectivenessCostCost per quality adjusted life year or disability adjusted life yearIncremental cost-effectiveness ratioPrior testsECG (MBS Items 11700, 11701, 11702)Clinical examination Invasive coronary angiography (MBS Item 38215-38246) or CTCA (MBS Items 57360, 57361)Echocardiography (MBS Items 55113, 55115)Reference standardMyocardial biopsy (MBS Item 38275)Research question for assessment: In patients with troponin-positive chest pain, ECG changes suspicious of ACS, and no culprit lesion identified on coronary angiography, what is the safety, effectiveness and cost-effectiveness of CMRI compared to watchful waiting in the context of optimal medical therapy?Population FivePopulation Five includes asymptomatic individuals with a family history of sudden cardiac death or aborted sudden cardiac death in a first-degree relative, excluding channelopathies and arrhythmia.Clinical claim for the proposed interventionThe primary use of CMRI in Population 5 is as an adjunct diagnostic tool. CMRI is intended to be used as an additional test to determine the presence of underlying disease in patients with a family history of sudden cardiac death or aborted sudden cardiac death in a first degree relative. For some patients, sudden death may be the first manifestation of cardiomyopathy. CMRI provides additional information beyond standard testing in regard to an assessment of LV structure and function, and can also provide information on tissue characterisation. Pre-symptomatic disease usually can be identified by echocardiography in patients with a family history of sudden cardiac death. Patients for whom the CMRI examination would be most useful include those with equivocal echocardiography findings, or those who have an affected relative with abnormal CMRI findings.The proposed benefits of CMRI in this population include:Earlier identification of disease in an affected first-degree relative.Increased sensitivity and specificity for identifying cardiomyopathy subtypes compared to comparator parator(s)In the absence of CMRI, asymptomatic patients with a family history of sudden cardiac death are managed through watchful waiting with regular follow-up. Therefore, the appropriate comparator to CMRI for Population Five is watchful waiting.Reference standard(s)There are currently no available diagnostic tests that can act as a reference test for sudden cardiac death. In the absence of diagnostic testing, watchful waiting with possible repeat evaluation every few years, dependent upon the pathology, is considered to be the imperfect reference standard.Clinical pathwayIn asymptomatic individuals with a family history of sudden cardiac death, CMRI is intended to be used as an adjunct diagnostic test to clinical evaluation, ECG, and transthoracic echocardiography. Other tests may depend upon the exact type of pathology being investigated. For example, holter monitors may also be applied. In the absence of clinical practice guidelines, the proposed clinical management algorithm for patients with a family history of sudden cardiac death was developed by the Assessment Group in consultation with the Applicant, and is presented in Figure 8.Figure SEQ Figure \* ARABIC 8:Proposed clinical management algorithm for asymptomatic individuals with a family history of sudden cardiac death or aborted sudden cardiac death in a first-degree relative.ECG=electrocardiography, Echo=echocardiography, ICD=implantable cardioverter defibrillator, MRI=magnetic resonance imaging.Health outcomesRelevant health outcomes for the investigation of CMRI in asymptomatic individuals with a family history of sudden cardiac death or aborted sudden cardiac death in a first-degree relative are outlined in Table 6.Economic evaluationThe economic evaluation for the proposed service is informed by the following clinical claims:Non-inferior safety and superior efficacy compared to non-invasive testing. In this context, the economic evaluation of the proposed service will be a cost-effectiveness analysis/cost-utility analysis.Summary of PICO criteriaTable SEQ Table \* ARABIC 6: Summary of PICO to define the research question(s) for Population FivePICO CriteriaCommentsPatientsAsymptomatic individuals with a family history of sudden cardiac death or aborted sudden cardiac death in a first-degree relative, excluding channelopathies and arrhythmia.InterventionMRI assessment of myocardial structure and function, including tissue characterisationComparatorWatchful waitingOutcomesSafetyGadolinium contrast adverse reactionClaustrophobiaPhysical harms from follow-up testingOther adverse events arising from CMRIEffectivenessHealth outcomesCardiac disease-specific mortalitySurvivalCardiac hospitalisationAdverse cardiac event over defined periodQuality of life scoresDiagnostic accuracySensitivity, specificity (confirmed by reference standard)Positive predictive value, negative predictive value (confirmed by reference standard)Positive likelihood ratio, negative likelihood ratio (confirmed by reference standard)ROC curvesUnsatisfactory or uninterpretable test resultsPatient managementChange in clinical diagnosisChange in treatment pathway (initiated, ceased, modified, avoided)Patient compliance with, preference for imagingTime to initial diagnosisTime from diagnosis to treatmentRates of re-interventionCost-effectivenessCostCost per quality adjusted life year or disability adjusted life yearIncremental cost-effectiveness ratioPrior testsClinical evaluation, ECG, transthoracic echocardiography. Other tests may depend upon the exact type of pathology being investigated. For example, holter monitors may also be applied.Reference standardWatchful waiting with possible repeat evaluation every few years dependent upon the pathology.Research question for assessment: In patients with a family history of sudden cardiac death or aborted sudden cardiac death in a first-degree relative, excluding channelopathies and arrhythmia; what is the safety, effectiveness and cost-effectiveness of CMRI compared to watchful waiting.Fee for the proposed medical serviceExplain the type of funding proposed for this service.The current application requests the listing of five new ‘Category 5 – Diagnostic Imaging Services’ Items on the MBS ( REF _Ref403128339 \h \* MERGEFORMAT Table 7) to include subtypes of cardiomyopathy. The proposed items are intended to be co-claimed with modifying item 63491 (fee: $44.80), which covers the cost of administering a contrast agent for eligible MRI scans.Table SEQ Table \* ARABIC 7: Proposed MBS Item for the investigation of suspected cardiomyopathies with CMRICategory 5 – Diagnostic Imaging ServicesMBS [item number (Note: this will be assigned by the Department if listed on the MBS)]NOTE: Benefits are payable for each service included by Subgroup ## on one occasion only in any 12 month period MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where the request for the scan specifically identifies the clinical indication for the scan - scan of cardiovascular system for:(a) assessment of myocardial structure and function, including tissue characterisation; and(b) the request for the scan identifies that the patient presents with:heart failure symptoms, in whom echocardiography is inconclusive or suggests a dilated cardiomyopathy, and in whom further diagnostic clarification is required; ora family history of non-ischaemic dilated cardiomyopathy in a first-degree relative in whom echocardiography is inconclusive.(Contrast)Fee: $855.20 Benefit: 75% = $641.40 85% = $726.90Category 5 – Diagnostic Imaging ServicesMBS [item number (Note: this will be assigned by the Department if listed on the MBS)]NOTE: Benefits are payable for each service included by Subgroup ## on one occasion only in any 12 month period MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where the request for the scan specifically identifies the clinical indication for the scan - scan of cardiovascular system for:(a) assessment of myocardial structure and function, including tissue characterisation; and(b) the request for the scan identifies that the patient presents with:echocardiography results suggesting increased left ventricular wall thickness, a hypertrophic or restrictive cardiomyopathy is suspected, and in whom further diagnostic clarification is required; ora family history of hypertrophic or restrictive cardiomyopathy in a first degree relative.(Contrast)Fee: $855.20 Benefit: 75% = $641.40 85% = $726.90Category 5 – Diagnostic Imaging ServicesMBS [item number (Note: this will be assigned by the Department if listed on the MBS)]NOTE: Benefits are payable for each service included by Subgroup ## on one occasion only in any 12 month period MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where the request for the scan specifically identifies the clinical indication for the scan - scan of cardiovascular system:(a) assessment of myocardial structure and function; and(b) the request for the scan identifies that the patient presents with:symptoms consistent with arrhythmic right ventricular cardiomyopathy on the basis of task force criteria; ora family history of arrhythmic right ventricular cardiomyopathy in a first degree relative.(Contrast)Fee: $855.20 Benefit: 75% = $641.40 85% = $726.90Category 5 – Diagnostic Imaging ServicesMBS [item number (Note: this will be assigned by the Department if listed on the MBS)]NOTE: Benefits are payable for each service included by Subgroup ## on one occasion only in any 12 month period MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where the request for the scan specifically identifies the clinical indication for the scan - scan of cardiovascular system for:(a) assessment of myocardial structure and function, including tissue characterisation; and(b) the request for the scan identifies that the patient presents with troponin-positive chest pain, electrocardiography changes suspicious of acute coronary syndrome, and no culprit lesion identified on coronary angiography.(Contrast)Fee: $855.20 Benefit: 75% = $641.40 85% = $726.90Category 5 – Diagnostic Imaging ServicesMBS [item number (Note: this will be assigned by the Department if listed on the MBS)]NOTE: Benefits are payable for each service included by Subgroup ## on one occasion only in any 12 month period MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or consultant physician and where the request for the scan specifically identifies the clinical indication for the scan - scan of cardiovascular system for:(a) assessment of myocardial structure and function, including tissue characterisation; and(b) the request for the scan identifies that the patient presents with a family history of sudden cardiac death or aborted sudden cardiac death in a first degree relative, excluding channelopathies and arrhythmia.(Contrast)Fee: $855.20 Benefit: 75% = $641.40 85% = $726.90Please indicate the direct cost of any equipment or resources that are used with the service relevant to this application, as appropriate. The total estimated cost of conducting one CMRI scan on one patient for suspected cardiomyopathies is estimated to range between $1,100 and $1,200. This estimated cost was suggested by the RANZCR, and is supported by the CSANZ. However, there is a high degree of variability and uncertainty in how the total cost is estimated, as it may be influenced by a range of factors relating to the time and labour resources, consumable resources, and capital resources used to perform the service.Consumable resourcesConsumable resources required to undertake a CMRI scan cost approximately $100 including the cost of gadolinium-based contrast. The consumable costs include:Linen = $5.00Cannula = $1.52ECG electrodes = $2.52Gadolinium contrast = ~$50Connecting tubing = $30.50Dual Syringe = $28Valves x 2 = $10.20Time and labour resourcesThe time to perform the scan is a significant factor in determining the overall cost of the service, which may vary significantly depending on the setting in which the scan is performed. In an efficient, high volume centre with highly trained and experienced CMRI staff, a scan for suspected cardiomyopathies may take 50 to 60 minutes. In a lower volume centre with less experience conducting CMRI, which is likely to be more common in private practice, CMRI scans take longer to perform. In low-volume centres, the time taken to conduct CMRI ranges between 60 to 80 minutes on average, as suggested by RANCR and supported by CSANZ; however, it is common for a scan for suspected ARVC to take in excess of 90 minutes. In such cases there will be additional costs in terms of time for radiographers and supervising clinicians.Another factor that can significantly affect the cost of the scan is whether or not specialist oversight is required during image acquisition. Although the application does not advocate for specialist oversight as a technical requirement for conducting CMRI in the proposed populations, Applicant experience suggests that specialist oversight may be necessary during the first five years of operation while the CMRI team is familiarising with the technique. Specialist oversight during image acquisition may also be required in a minority of challenging cases, even in experienced teams.A summary of the time and labour resource costs associated with CMRI in Australian private practice are presented in REF _Ref418601891 \h \* MERGEFORMAT Table 8. The resource costs should be confirmed during the assessment phase.Table SEQ Table \* ARABIC 8Estimated human resource costs associated CMRI in Australian private practiceResourceNurse/ReceptionistRadiographerRadiologist/CardiologistAverage Estimated TimePre-scan patient briefing10 mins10 – 15 mins-Image acquisition-60 – 80 mins60 – 80 mins?Software analysis-15 – 30 mins-Specialist reporting--15 – 30 minsPost-scan patient briefing10 mins--Total time20 mins85 – 125 mins75 – 110 minsEstimated Rate$25 per hour$49 per hour*$300 per hour**Total cost$8$70-$100$375-$550?While it is not a fixed requirement that a cardiologist/radiologist be present during a CMRI scan for cardiomyopathies, Applicant feedback suggests this is common in clinical practice - particularly while radiographers are being trained in CMRI.*Estimate based on NSW state award rate for Level 3, Grade 1 Year 1 radiographers.**Estimate based on Applicant feedback, but may be highly variable.Capital resourcesIt is difficult to estimate the capital costs associated with conducted CMRI, as MRI units often used for a range of indications; however, the Applicant has emphasised that some MRI units are utilised exclusively for cardiac indications overseas. The capital costs associated with operating a MRI unit include:MRI scanner $1-1.5 million for 1.5T, $1.7-2.5 million for 3T magnet purchaseFit-out $150-200,000Resuscitation equipment – cost unknownPicture Archiving Communication System (PACS) and Radiology Information System (RIS) – cost unknownWorkstation $100,0003rd party Cardiac software $20,000Maintenance and upgrades – 1.5 T or 3T $140-160,000 per year, quarterly serviceAs MRI units in Australia are most often used for a range of indications, the opportunity costs associated with conducting CMRI should also be accounted for when estimating the overall cost of the service. The MRI costs relevant to this application should be confirmed during the assessment phase.Provide details of the proposed fee.The proposed fee in the original application was $700 for CMRI in patients with suspected cardiomyopathies (inclusive of the $44.80 fee for item 63491). Feedback from the RANZCR and private CMRI specialists suggests that patients will be required to pay a significant gap payment at the proposed fee level, depending on where the scan is performed. There are two key scenarios in which CMRI may be used that will affect the cost of the service:In a high volume centre with expertise in CMRI and relatively fast scan acquisition times, a fee of $655.20 for the proposed service, plus an additional $44.80 for co-claimed item 63491, might be adequate ($700 total fee).In a lower volume centre, including smaller private practice clinics, a fee of $855.20 for the proposed service, plus an additional $44.80 for co-claimed item 63491, would be more appropriate ($900 total fee).Expert advice suggests that many private practices will not cover costs with a $700 total fee for standard cardiac scans. One of Australia’s largest private hospitals charges $750 for a private CMRI scan without any stress agent (equivalent to the types of MRI scan performed in this protocol). This scan is allocated for one hour, and is run at a loss. In other private practices with less experienced technicians the scans take between 90-120 mins. It is suggested that a $900 total fee for a cardiomyopathy scan (i.e. CMRI with Gadolinium contrast but without a stress agent) would minimise gap payments.The proposed fees are considered to be a conservative estimate compared to the existing rebate for CTCA (MBS Item 57360, fee $700), a comparator test that involves the use of machines that are less expensive than MRI, and require less time for image acquisition, software analysis and reporting. Healthcare resourcesUsing Table 8, provide a list of the health care resources whose utilisation is likely to be impacted should the proposed intervention be made available as requested whether the utilisation of the resource will be impacted due to differences in outcomes or due to availability of the proposed intervention itself. See Table 8 below.Questions for public fundingPlease list questions relating to the safety, effectiveness and cost-effectiveness of the service / intervention relevant to this application, for example:Which health / medical professionals provide the serviceAre there training and qualification requirementsAre there accreditation requirementsThe primary questions for public funding are listed in section 4, following the PICO table for each proposed population. In addition to the primary questions relating to the safety, effectiveness and cost-effectiveness of the service, the assessment phase should aim to answer the following secondary questions:What proportion of operational time are eligible MRI units likely to be used for CMRI?Table SEQ Table \* ARABIC 9: List of resources to be considered in the economic analysisProvider of resourceSetting in which resource is providedProportion of patients receiving resourceNumber of units of resource per relevant time horizon per patient receiving resourceDisaggregated unit costMBSItemSafety nets*Other government budgetPrivate health insurerPatientTotal costResources provided to identify eligible population General Practice consultationGPOutpatient100TBDTBDSpecialist consultationSpecialistOutpatient100TBDTBDECGGP or SpecialistOutpatient or inpatient100TBD117001170111702TBDEchocardiographyGP or SpecialistOutpatient or inpatient100TBD551135511555118TBDResources provided to deliver proposed interventionMagnetic Resonance ScannerSpecialistOutpatient or inpatient100TBDTBDCMRI workstation and softwareSpecialistOutpatient or inpatient100TBDTBDGadoliniumRadiographerOutpatient or inpatient90-100TBD63491TBDLinenRadiographerOutpatient or inpatient100TBDTBDDual SyringeRadiographerOutpatient or inpatient90-100TBDTBDCannulaRadiographerOutpatient or inpatient90-100TBDTBDConnecting tubesRadiographerOutpatient or inpatient90-100TBDTBDECG ElectrodesRadiographerOutpatient or inpatientTBDTBDTBDResources provided in association with proposed interventionTBDTBDResources provided to deliver comparator testsMyocardial biopsy SpecialistOutpatient or inpatientTBDTBD38275TBDInvasive coronary angiographySpecialistOutpatient or inpatientTBDTBD38215-38246TBDCTCASpecialistOutpatient or inpatientTBDTBD5736057361TBDSPECTSpecialistOutpatient or inpatientTBDTBD6130261303613066130761651616526165361654TBDGenetic testingSpecialistOutpatient or inpatientTBDTBD73317TBDEchocardiographySpecialistOutpatient or inpatientTBDTBD551135511555118TBDSignal-averaged ECGSpecialistOutpatient or inpatientTBDTBD11713TBDHolter monitoringSpecialistOutpatient or inpatientTBDTBD11709TBDExercise stress testingSpecialistOutpatient or inpatientTBDTBD11712TBDResources provided in association with comparator testsTBDTBDResources associated with patient management following diagnosisMedical therapySpecialistOutpatient or inpatientTBDTBDTBDImplantable cardiac defibrillator (insertion and monitoring)SpecialistOutpatient or inpatientTBDTBD117272194138212382133838438387TBDHeart transplantSpecialistOutpatient or inpatientTBDTBDTBDSpecialist consultationSpecialistOutpatient or inpatientTBDTBDTBDCMRI=cardiac magnetic resonance imaging, CTCA=computed tomography coronary angiography, ECG=electrocardiography, GP=general practitioner, MBS=medical benefits schedule, SPECT=single-photon emission computed tomography, TBD=to be determined.* Includes costs relating to both the standard and extended safety net.References ADDIN EN.REFLIST 1.Bruder O, Wagner A, Lombardi M, Schwitter J, van Rossum A, Pilz G, et al. European Cardiovascular Magnetic Resonance (EuroCMR) registry--multi national results from 57 centers in 15 countries. J Cardiovasc Magn Reson. 2013;15:9.2.Hendel RC, Patel MR, Kramer CM, Poon M, Carr JC, Gerstad NA, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48(7):1475-97.3.Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S. The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol. 2009;54(15):1407-24.4.Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010;55(23):2614-62.5.Salerno M, Kramer CM. Advances in Cardiovascular MRI for Diagnostics: Applications in Coronary Artery Disease and Cardiomyopathies. Expert Opin Med Diagn. 2009;3(6):673-87.6.Bruder O, Schneider S, Nothnagel D, Dill T, Hombach V, Schulz-Menger J, et al. EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase. J Am Coll Cardiol. 2009;54(15):1457-66.7.Department of Health. Magnetic Resonance Imaging Canberra: Australian Government; 2014 [cited 2013 10 September]. Available from: Department of Health. Magnetic Resonance Imaging Canberra: Australian Government; 20148.Medical Advisory Secretariat. Magnetic resonance imaging (MRI) for the assessment of myocardial viability: an evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(15):1-45.9.National Heart Foundation. Guidelines for the prevention, detection and management of chronic heart failure in Australia. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (Chronic Heart Failure Guidelines Expert Writing Panel), 2011.10.NICE. Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care: National Institue for Health and Care Excellence; 2010 [cited 2014 16 October]. Available from: NICE. Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care: National Institue for Health and Care Excellence; 2010.11.NICE. Acute heart failure: Diagnosing and managing acute heart failure in adults: National Insitute of Health and Care Excellence; 2014 [cited 2014 16 October]. Available from: NICE. Acute heart failure: Diagnosing and managing acute heart failure in adults: National Insitute of Health and Care Excellence; 2014.12.Health Insurance (Diagnostic Imaging Services Table) Regulation 2013 Division 2.5—Group I5: magnetic resonance imaging (2013).13.Budoff MJ, Cohen MC, Garcia MJ, Hodgson JM, Hundley WG, Lima JA, et al. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol. 2005;46(2):383-402.14.SCMR. Guidelines for credentialing in cardiovascular magnetic resonance (CMR). Society for Cardiovascular Magnetic Resonance (SCMR) Clinical Practice Committee. J Cardiovasc Magn Reson. 2000;2(3):233-4.15.van der Graaf AW, Bhagirath P, Gotte MJ. MRI and cardiac implantable electronic devices; current status and required safety conditions. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2014;22(6):269-76.16.Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2013;15(8):1070-118.17.Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29(2):270-6.18.Hershberger RE, Siegfried JD. Update 2011: clinical and genetic issues in familial dilated cardiomyopathy. J Am Coll Cardiol. 2011;57(16):1641-9.19.Codd MB, Sugrue DD, Gersh BJ, Melton LJ, 3rd. Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. A population-based study in Olmsted County, Minnesota, 1975-1984. Circulation. 1989;80(3):564-72.20.Elliott P, McKenna WJ. Hypertrophic cardiomyopathy. Lancet. 2004;363(9424):1881-91.21.Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58(25):e212-60.22.Chan AK, Somarouthu B, Ghoshhajra B. Magnetic resonance imaging for hypertrophic cardiomyopathy update. Topics in magnetic resonance imaging : TMRI. 2014;23(1):33-41.23.Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J. 2010;31(7):806-14.24.Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. Jama. 2011;306(3):277-86.25.Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. American heart journal. 2008;155(3):408-17.26.Collste O, Sorensson P, Frick M, Agewall S, Daniel M, Henareh L, et al. Myocardial infarction with normal coronary arteries is common and associated with normal findings on cardiovascular magnetic resonance imaging: results from the Stockholm Myocardial Infarction with Normal Coronaries study. Journal of internal medicine. 2013;273(2):189-96.27.AIHW. Cardiovascular disease: Australian facts 2011. Canberra: Australian Institute of Health and Welfare, 2011 Contract No.: Cat. no. CVD 53.28.ABS. 3303.0 - Causes of Death, Australia, 2012 Canberra: Australian Bureau of Statistics; 2012 [cited 2014 16 October]. Available from: ABS. 3303.0 - Causes of Death, Australia, 2012 Canberra: Australian Bureau of Statistics; 2012.29.Australian Insitute of Health and Welfare. Separation statistics by principal diagnosis in ICD-10-AM: AIHW; 2013 [cited 2013 20 June]. Available from: Australian Insitute of Health and Welfare. Separation statistics by principal diagnosis in ICD30.Romero J, Mejia-Lopez E, Manrique C, Lucariello R. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC/D): A Systematic Literature Review. Clinical Medicine Insights Cardiology. 2013;7:97-114.31.ABS. 3101.0 - Australian Demographic Statistics, Mar 2013 Canberra, Australia: Australian Bureau of Statistics; 2013 [cited 2014 November 7]. Available from: Australian Demographic Statistics, Mar 2013 Canberra, Australia.32.AIHW. Australia’s health 2014. Canberra: Australian Institute of Health and Welfare,, 2014.33.Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ, Kramer CM, Salerno M. Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circulation Cardiovascular imaging. 2014;7(2):250-8.34.Green JJ, Berger JS, Kramer CM, Salerno M. Prognostic value of late gadolinium enhancement in clinical outcomes for hypertrophic cardiomyopathy. JACC Cardiovasc Imaging. 2012;5(4):370-7.35.Leong DP, Chakrabarty A, Shipp N, Molaee P, Madsen PL, Joerg L, et al. Effects of myocardial fibrosis and ventricular dyssynchrony on response to therapy in new-presentation idiopathic dilated cardiomyopathy: insights from cardiovascular magnetic resonance and echocardiography. Eur Heart J. 2012;33(5):640-8.36.To AC, Dhillon A, Desai MY. Cardiac magnetic resonance in hypertrophic cardiomyopathy. JACC Cardiovasc Imaging. 2011;4(10):1123-37.37.Srinivasan G, Joseph M, Selvanayagam JB. Recent advances in the imaging assessment of infiltrative cardiomyopathies. Heart (British Cardiac Society). 2013;99(3):204-13.38.Dickerson JA, Raman SV, Baker PM, Leier CV. Relationship of cardiac magnetic resonance imaging and myocardial biopsy in the evaluation of nonischemic cardiomyopathy. Congestive heart failure (Greenwich, Conn). 2013;19(1):29-38.39.Assomull RG, Shakespeare C, Kalra PR, Lloyd G, Gulati A, Strange J, et al. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation. 2011;124(12):1351-60.40.Walker S, Girardin F, McKenna C, Ball SG, Nixon J, Plein S, et al. Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study. Heart (British Cardiac Society). 2013;99(12):873-81.41.Boldt J, Leber AW, Bonaventura K, Sohns C, Stula M, Huppertz A, et al. Cost-effectiveness of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary artery disease in Germany. J Cardiovasc Magn Reson. 2013;15:30.42.McCrohon JA, Moon JC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJ, et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003;108(1):54-9.43.Leyva F, Taylor RJ, Foley PW, Umar F, Mulligan LJ, Patel K, et al. Left ventricular midwall fibrosis as a predictor of mortality and morbidity after cardiac resynchronization therapy in patients with nonischemic cardiomyopathy. J Am Coll Cardiol. 2012;60(17):1659-67.44.Gulati A, Jabbour A, Ismail TF, Guha K, Khwaja J, Raza S, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. Jama. 2013;309(9):896-908.45.Moon JC, Fisher NG, McKenna WJ, Pennell DJ. Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography. Heart (British Cardiac Society). 2004;90(6):645-9.46.Bogaert J, Olivotto I. MR Imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedside. Radiology. 2014;273(2):329-48.47.Hoey ET, Neil-Gallagher E. Utility of gadolinium enhanced cardiovascular MRI to differentiate Fabry's disease from other causes of hypertrophic cardiomyopathy. Postgraduate medical journal. 2012;88(1046):731-2.48.Austin BA, Tang WH, Rodriguez ER, Tan C, Flamm SD, Taylor DO, et al. Delayed hyper-enhancement magnetic resonance imaging provides incremental diagnostic and prognostic utility in suspected cardiac amyloidosis. JACC Cardiovasc Imaging. 2009;2(12):1369-77.49.Rickers C, Wilke NM, Jerosch-Herold M, Casey SA, Panse P, Panse N, et al. Utility of cardiac magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Circulation. 2005;112(6):855-61.50.Valente AM, Lakdawala NK, Powell AJ, Evans SP, Cirino AL, Orav EJ, et al. Comparison of echocardiographic and cardiac magnetic resonance imaging in hypertrophic cardiomyopathy sarcomere mutation carriers without left ventricular hypertrophy. Circulation Cardiovascular genetics. 2013;6(3):230-7.51.Banypersad SM, Fontana M, Maestrini V, Sado DM, Captur G, Petrie A, et al. T1 mapping and survival in systemic light-chain amyloidosis. Eur Heart J. 2015;36(4):244-51.52.White JA, Kim HW, Shah D, Fine N, Kim KY, Wendell DC, et al. CMR imaging with rapid visual T1 assessment predicts mortality in patients suspected of cardiac amyloidosis. JACC Cardiovasc Imaging. 2014;7(2):143-56.53.Taylor AJ, Ellims A, Lew PJ, Murphy B, Pally S, Younie S. Impact of cardiac magnetic resonance imaging on cardiac device and surgical therapy: a prospective study. The international journal of cardiovascular imaging. 2013;29(4):855-64.54.Borgquist R, Haugaa KH, Gilljam T, Bundgaard H, Hansen J, Eschen O, et al. The diagnostic performance of imaging methods in ARVC using the 2010 Task Force criteria. European heart journal cardiovascular Imaging. 2014;15(11):1219-25.55.Gerbaud E, Harcaut E, Coste P, Erickson M, Lederlin M, Labeque JN, et al. Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. The international journal of cardiovascular imaging. 2012;28(4):783-94.56.te Riele AS, Bhonsale A, James CA, Rastegar N, Murray B, Burt JR, et al. Incremental value of cardiac magnetic resonance imaging in arrhythmic risk stratification of arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol. 2013;62(19):1761-9.57.Mavrogeni S, Anastasakis A, Sfendouraki E, Gialafos E, Aggeli C, Stefanadis C, et al. Ventricular tachycardia in patients with family history of sudden cardiac death, normal coronaries and normal ventricular function. Can cardiac magnetic resonance add to diagnosis? International journal of cardiology. 2013;168(2):1532-3.58.The Department of Health. Magnetic Resonance Imaging (MRI): The Department of Health; 2013 [updated 13 December 2013; cited 2014 5 March]. Available from: The Department of Health. Magnetic Resonance Imaging (MRI): The Department of Health.59.Yoshida A, Ishibashi-Ueda H, Yamada N, Kanzaki H, Hasegawa T, Takahama H, et al. Direct comparison of the diagnostic capability of cardiac magnetic resonance and endomyocardial biopsy in patients with heart failure. European journal of heart failure. 2013;15(2):166-75.60.Joshi SB, Connelly KA, Jimenez-Juan L, Hansen M, Kirpalani A, Dorian P, et al. Potential clinical impact of cardiovascular magnetic resonance assessment of ejection fraction on eligibility for cardioverter defibrillator implantation. J Cardiovasc Magn Reson. 2012;14:69.61.Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.62.Paech DC, Weston AR. A systematic review of the clinical effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of suspected coronary artery disease. BMC cardiovascular disorders. 2011;11:32.63.Fatkin D. Guidelines for the diagnosis and management of familial dilated cardiomyopathy. Heart Lung Circ. 2011;20(11):691-3.64.McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787-847.65.Moon JC, Mogensen J, Elliott PM, Smith GC, Elkington AG, Prasad SK, et al. Myocardial late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy caused by mutations in troponin I. Heart (British Cardiac Society). 2005;91(8):1036-40.66.Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):1977-2016.67.Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733-79.68.Anderson EL. Arrhythmogenic right ventricular dysplasia. American family physician. 2006;73(8):1391-8.69.Liu T, Pursnani A, Sharma UC, Vorasettakarnkij Y, Verdini D, Deeprasertkul P, et al. Effect of the 2010 task force criteria on reclassification of cardiovascular magnetic resonance criteria for arrhythmogenic right ventricular cardiomyopathy. J Cardiovasc Magn Reson. 2014;16:47.70.Looi KL, Edwards C, Hart H, Christiansen JP. Utility of cardiac magnetic resonance in the evaluation of unselected patients with possible arrhythmogenic right ventricular cardiomyopathy. Clinical Medicine Insights Cardiology. 2012;6:153-62.71.Roe MT, Harrington RA, Prosper DM, Pieper KS, Bhatt DL, Lincoff AM, et al. Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease.The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigators. Circulation. 2000;102(10):1101-6.72.Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. The New England journal of medicine. 1999;341(4):226-32.73.Aretz HT, Billingham ME, Edwards WD, Factor SM, Fallon JT, Fenoglio JJ, Jr., et al. Myocarditis. A histopathologic definition and classification. The American journal of cardiovascular pathology. 1987;1(1):3-14.74.Assomull RG, Lyne JC, Keenan N, Gulati A, Bunce NH, Davies SW, et al. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Eur Heart J. 2007;28(10):1242-9. ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- nevada department of health license
- colorado department of health and human services
- nevada department of health licensing
- ny state department of health forms
- department of health certification illinois
- nys department of health license verifica
- new york department of health license lookup
- bergen county department of health services
- tennessee department of health license renewal
- department of health jobs pa
- colorado department of health and environment
- tn department of health licensure