We are pleased to provide below, our Inaugural ANZCMR Newsletter – a place for all things CMR!
In this Newsletter, we have showcased important issues for our local Australia and New Zealand landscape.
We also invite you to become involved in the ANZCMR Working Group and in advocating for our patients.
Australia and New Zealand Working Group for Cardiovascular MRI
Providing a centralised,
coherent voice that
scientifically & politically.
The Official Quarterly Newsletter of ANZCMR – the working group for Cardiovascular Magnetic Resonance Imaging
JULY 2022 – ISSUE 1
Message from the President
– Professor Andrew Taylor
On behalf of the ANZ CMR Working Group, it gives me great pleasure to welcome you all to the first edition of our long overdue ANZ CMR newsletter. In what we hope will be an informative quarterly update, we will keep you abreast of all the important developments in the changing landscape of CMR in Australia and New Zealand.
Over the last few years, we have made considerable progress in the provision of CMR services which were really accelerated by the first new Medicare item number for CMR for the evaluation of arrhythmogenic right ventricular cardiomyopathy (ARVC). Whilst initially we would have hoped for a broader range of rebateable cardiomyopathy indications for CMR, the new ARVC rebate provided an important first step for the acceptance and integration of CMR as a critical investigation in a wide range of cardiac diseases. With the help of our radiology colleagues, we have founded a conjoint committee for the certification of CMR providers, developing a bilaterally accepted (CSANZ and RANZCR) set of training standards and also developed the regulatory framework for provision of Medicare funded CMR services across Australia. This has been an outstanding achievement and I am truly grateful for all those, too many to mention individually, who contributed so much to what at times had seemed like a Sisyphean task.
More recently, the Working Group advocated strongly for a new item number for CMR in the assessment of vaccine associated myocarditis, leading to a temporary Medicare CMR item number for this important indication. Whilst this item number was initially only valid for CMR scans performed up to 30th June 2022, we have recently been advised that there will be some extension of this item number beyond this date. Importantly, CSANZ have just submitted a formal application for a new Medicare item number for CMR for the more general indication of myocarditis (application 1317), which is open for public consultation until July 8th. We remain hopeful of a positive response, and PASC/PICO assessment is underway with further meetings on 11th August to progress the application process.
In addition to its commitment to advocate for greater support of CMR as a clinical service across Australia and New Zealand, the Working Group continues to develop educational resources and promote research and training opportunities. Several of these will be highlighted in this newsletter but for a comprehensive overview I would direct you to our ANZ CMR website. Perhaps the most important to mention at this juncture is the hosting of this year’s CMR Australia conference in Melbourne 2022. After 2 years of being cruelled by COVID-19 restrictions we are delighted to be able to host this important event again and look forward to your participation.
Journal Watch Comment
– Professor Christian Hamilton-Craig
Seraphim et al. Quantitative Myocardial Perfusion Predicts Outcomes in Patients With Prior Surgical Revascularization
J Am Coll Cardiol. 2022 Mar, 79 (12) 1141–1151
Stress perfusion CMR using adenosine as a vasodilator stressor is a well-established technique for the imaging of myocardial perfusion, but has poor uptake in Australia due to lack of reimbursement, as well as lack of experienced operators trained in the technique.
There have been a number of large-scale randomized clinical trials which have shown the diagnostic accuracy, comparative efficacy, health economics, and prognostic data derived from Stress-CMR. Compared to the gold standard invasive fractional flow reserve (FFR), stress CMR with adenosine has a high sensitivity of 91% and specificity of 94% for identification of lesion-specific ischemia.
Until recently, visual analysis of grey-scale images is the main, subjective method for analysing Stress-CMR. Recently, new pixel-wise quantitative mapping techniques have emerged for the automated, in-line quantitation of myocardial perfusion using adenosine Stress CMR.
Stress CMR with AI multi-layer convolution neural network with in-line delineation of the left ventricle cavity and myocardium, excluding myocardial fat and papillary muscles, without any human interaction with the image data (figure below).
Seraphim et al (JACC 2022) evaluated whether global stress myocardial blood flow (MBF) and perfusion reserve (MPR) derived from perfusion mapping cardiac magnetic resonance (CMR) independently predict adverse outcomes in patients with prior CABG. They found that global stress MBF and MPR derived from perfusion CMR independently predict adverse outcomes in patients with previous CABG, and this effect was independent from the presence of regional ischemia on visual assessment, and also the extent of previous infarction seen on LGE imaging.
This shows that Stress CMR is valid in patients post-CABG, and the in-line quantitative perfusion mapping improves assessment and prognostic value of Stress CMR.
Meet the ANZCMR Board
Professor Andrew Taylor
Cardiologist and Director of Cardiac MRI
Department of Cardiology, Alfred Hospital, Melbourne
Dr Rebecca Kozor
Cardiologist, Royal North Shore Hospital, Sydney
Senior Lecturer, University of Sydney
Co-Director of the University of Sydney CMR Group
Dr Preeti Choudhary
Cardiologist and specialist in cardiac MRI and adult congenital heart disease at Westmead, Blacktown and Auburn hospitals
Professor Martin Ugander
Professor of Cardiac Imaging, University of Sydney
Dr John Younger
Cardiologist, Royal Brisbane and Women's Hospital, Brisbane
University of Queensland
RANZCR / CSANZ / ANZCMR Conjoint Committee
Professor Christian Hamilton-Craig
Director, Noosa Hearts Cardiology
Professor, University of Queensland Faculty of Medicine & Centre for Advanced Imaging
Call for Nominations for State Representatives
We are looking for an individual to represent each state in Australia and two representatives from New Zealand.
You will be the link between the ANZCMR team and other CMR clinicians within your region.
Please email firstname.lastname@example.org with your CV and any questions you may have.
Submissions close 31 August 2022.
2022 CMR AUSTRALIA MASTERCLASS
12th November 2022
8.30am - 4.00 pm
Alfred Hospital Innovation and Education Hub
75 Commercial Road
Melbourne VIC 3004
ALTERNATIVE: Webinar via Zoom
Masterclass Registration Fees
IN PERSON ATTENDEE
includes 12-month ANZCMR membership
WEBINAR VIA ZOOM
includes 12-month ANZCMR membership
MSAC Application 1713
Cardiac MRI in the Diagnosis of Myocarditis
The Cardiac Society of Australia and New Zealand (CSANZ), together with Australia and New Zealand Working Group for MRI, have submitted an application for a new MBS item number for 'Cardiac MRI in the Diagnosis of Myocarditis'.
As part of the appraisal process, the Medical Services Advisory Committee (MSAC) invited input on the application from a range of stakeholders, through both targeted and public consultation which closed on 8th July.
The society of cardiovascular magnetic resonance (SCMR) submitted an application of support, along with the cardiac society and multiple stakeholders.
The next step is a PASC meeting for this application, scheduled for 11 August 2022.