Abstract
Background
To promote the rational use of cardiovascular imaging in patients with congenital
heart disease, the American College of Cardiology developed Appropriate Use Criteria
(AUC), but its clinical application and pre-release benchmarks have not been evaluated.
We aimed to evaluate the appropriateness of indications for cardiovascular magnetic
resonance (CMR) and cardiovascular computed tomography (CCT) in patients with conotruncal
defects and to identify factors associated with maybe or rarely appropriate (M/R)
indications.
Methods
Twelve centers each contributed a median of 147 studies performed prior to AUC publication
(01/2020) on patients with conotruncal defects. To incorporate patient characteristics
and center-level effects, a hierarchical generalized linear mixed model was used.
Results
Of the 1753 studies (80% CMR, and 20% CCT), 16% were rated M/R. Center M/R ranged
from 4 to 39%. Infants accounted for 8.4% of studies. In multivariable analyses, patient-
and study-level factors associated with M/R rating included: age <1 year (OR 1.90
[1.15–3.13]), truncus arteriosus (vs. tetralogy of Fallot, OR 2.55 [1.5–4.35]), and
CCT (vs. CMR, OR 2.67 [1.87–3.83]). None of the provider- or center-level factors
reached statistical significance in the multivariable model.
Conclusions
Most CMRs and CCTs ordered for the follow-up care of patients with conotruncal defects
were rated appropriate. However, there was significant center-level variation in appropriateness
ratings. Younger age, CCT, and truncus arteriosus were independently associated with
higher odds of M/R rating. These findings could inform future quality improvement
initiatives and further exploration of factors resulting in center-level variation.
Graphical abstract
This multicenter study evaluates the appropriateness of cardiovascular magnetic resonance
(CMR) and cardiovascular computed tomography (CCT) in patients with conotruncal defects
prior to the release of the Appropriate Use Criteria (AUC). Of the 1753 studies (80%
CMR, and 20% CCT), 16% were for maybe or rarely appropriate (M/R) indications. Center
M/R ranged from 4 to 39%. The patient- and study-level factors associated with M/R
rating included: age <1 year, truncus arteriosus, and CCT. Though most CMRs and CCTs
were rated appropriate, there were significant center-level variations in appropriateness
ratings that need further exploration.
Keywords
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Article info
Publication history
Published online: March 01, 2023
Accepted:
January 24,
2023
Received in revised form:
December 11,
2022
Received:
November 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Society of Cardiovascular Computed Tomography.
