The European Association of Cardiovascular Imaging’s (EACVI’s) Research & Innovation committee has conducted a number of research projects during the past two years, and the results of several that aim to show the value of cardiovascular imaging and prove its cost-effectiveness will be presented during EuroEcho– Imaging 2016.
In general, there have been few instances in which a specific imaging tool currently used in cardiology has been demonstrated to have a direct impact on the treatment and the prognosis of the patient.
Until now, the evidence supporting the use of imaging techniques, even in ischaemic heart disease, has been very weak. We are therefore aiming to use the capabilities of the EACVI in general and the committee in particular to build large-scale studies to try to demonstrate that we can, thanks to the new imaging techniques, have an impact on patient outcomes.
Specifically, we want to use the Research & Innovation committee of the EACVI, to push for prospective, large-scale multicentre studies to try to show that, with echocardiography, cardiac magnetic resonance imaging or nuclear cardiac imaging, we can positively impact the way in which the patient will be treated and, in turn, improve the patient’s prognosis. This is our goal.
Another key area in which largescale studies could be of benefit is that of showing cost-effectiveness. The problem is that, currently, if you perform cardiac magnetic resonance or if you use echocardiography, you think that you are being useful to your patient, but, as I mentioned, that has not been clearly demonstrated.
However, if we are able to show that performing echocardiography and cardiovascular imaging is clinically useful, it should be possible to also show that the technique is cost effective. That might be a way to make sure that the cost burden of, for instance, cardiac magnetic resonance is reimbursed at the real cost of the examination.
If we use France as an example, the reimbursement received for cardiac magnetic resonance is probably significantly below the cost of the examination in real terms. We therefore have to work really hard to demonstrate that we need these kinds of techniques, that they will improve the treatment of the patient, and that they will improve patient outcomes and therefore reduce ongoing healthcare costs.
To be able to show that echocardiography and cardiovascular imaging have a significant impact on patient outcomes and are cost effective, it is crucial that any studies include as many patients as possible, from as many centres as possible.
It is therefore important that they are conducted on a pan-European level. We are fortunate that the EACVI is a huge association, with a large number of members from across the continent. Moreover, we have many people close to the association are who are not only able to participate in our research projects but are also eager to take part.
In particular, we have many friends from the eastern part of Europe who are happy to participate in our projects and provide their data, which has clearly shown that what they are doing is close to what we are doing in the western part of Europe and is a valuable contribution.
The first major project that will be presented at EuroEcho–Imaging 2016 is the EURO-FILLING study, which is the first muticentre, prospective investigation performed in Europe through the EACVI comparing the value of echocardiographic assessment of filling pressures against invasive measurements (left ventricular end-diastolic pressure).1 Specifically, the study aims to validate the E/e‘ratio, alongside additional non-invasive estimates, against simultaneously measured left ventricular filling pressure obtained by left heart catheterization in echocardiography laboratories in eight reference European centres in a wide population sample size of cardiac patients with and without heart failure.
The study has now been completed and the results will be published very soon, with a first look at the findings to be presented in Leipzig.
The Research & Innovation committee has also been working on several other projects, including a metaanalysis using individual participant data conducted with Julien Magne, Limoges, France. This analysis combines all of the existing data in the field to determine whether global longitudinal strain is a prognostic marker in asymptomatic patients with severe aortic valve stenosis who have a preserved left ventricular ejection fraction. (To find out more about this study and to read an interview with Dr. J. Magne, turn to page 4.)
The third project that will be discussed at EuroEcho–Imaging 2016 is a registry involving the young community on the current situation with low flow, low gradient aortic valve stenosis.
Finally, we are starting an observational, prospective, multimodality imaging study called EuroCRT to examine the ability of cardiac magnetic resonance and echocardiographic findings to predict patient responses to cardiac resynchronization therapy (CRT).
This is an important project, as there has been no large study in the literature that has been able to demonstrate any beneficial effect of the use of imaging techniques in the field of CRT. However, we believe that, with the latest technologies and by combining cardiac magnetic resonance and echocardiography, we can better select the patients that might be responders to CRT.
We therefore designed a prospective, observational study involving 10–15 European centres, with the goal being to include 250 patients to undergo cardiac magnetic resonance imaging and echocardiography before implantation of CRT. These patients will then be re-evaluated six months after the procedure. We are hoping that we might be able to demonstrate that this combination of imaging techniques is capable of defining responders and non-responders to CRT through the identification of reproducible markers.
We have been able to undertake this study thanks to the EACVI and the efforts of the Research & Innovation committee. Once we have published the results, we hope to be able to convert it into a Horizon 2020 project (see Box), and have therefore applied for a grant from the European Union. We aim to conduct a prospective, randomized study comparing the conventional use of CRT against conventional use plus combined cardiac magnetic resonance imaging and echocardiography in the selection of candidates for CRT.
1. Galderisi M, Lancellotti P, Donal E et al. European multicentre validation study of the accuracy of E/e’ ratio in estimating invasive left ventricular filling pressure: EURO-FILLING study. Eur Heart J Cardiovasc Imaging 2014; 15: 810–816.
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