Abstract 15277: Monitoring progression of aneurysms of the ascending aorta: Timing, cost and radiation exposure

Abstract 15277: Monitoring progression of aneurysms of the ascending aorta: Timing, cost and radiation exposure

Callow AE; Long J; Rehman S; Khaliq IH; Boland S; Mikolich JR

Circulation

2020

2020-11-17

Introduction: Current guidelines of the American Heart Association (AHA) recommend annual serial imaging for patients with aneurysm of the ascending aorta (AscAoA). However, recent data (Park K-H et al. Eur J CT Surg 2017;51:959-64) have suggested that this imaging frequency may not be necessary. This study was designed to compare the progression in growth rates of AscAoA using cardiac MRI (CMR) in 2 large cohorts of patients reassessed every 1 year and every 2 years.Methods: An institutional cardiac imaging database was queried for all patients with AscAoA, defined as a maximum ascending aorta diameter > 3.5 cm measured perpendicular to flow using CMR. The study cohort was divided into two groups; patients who had a follow up CMR every 1 (Group A), and those who had a CMR every 2 years (Group B). AscAoA growth rates were computed for each group and statistically compared using a two-sample t-test. For analysis of cost to the healthcare system, Medicare reimbursement rates for 2019 were utilized. Published mean radiation dose for cardiac CT (CCT) was utilized to assess radiation exposure.Results: Of 6,210 patients in the cardiac imaging database, 1,849 had a diagnosis of AscAoA, of which 941 had serial CMR studies. Of these 941 patients, 342 had a follow up CMR every 1 year, while 206 had a follow up CMR every 2-years. The mean progression of AscAoA was 0.0247 ± 0.475 cm for Group A and 0.0598 ± 0.209 cm for Group B. The growth rate of AscAoA was not significantly different between groups (p=0.236). The Medicare reimbursement for CMR was $23,056 per 100 patients (CPT 75557) without radiation exposure. If CCT had been used for these patients, Medicare reimbursement would have been $20,174 per 100 patients (CPT 75572) with exposure to 10.5 mSv of radiation per study.Conclusions: There was no significant difference in progression of AscAoA diameter between Groups A and B. These data suggest that serial imaging of AscAoA every 2 years may be appropriate, with reduced cost to the healthcare system and cumulative radiation exposure. Although CMR is slightly more costly than CCT, it eliminates cumulative breast radiation exposure, a feature of particular importance for female patients.

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journalArticle

A15277-A15277

Suppl 3

142

0009-7322

NEOMED College of Medicine Student

NEOMED Student Publications

December 2020 List