Diagnostic and Clinical Impact of Cardiac Magnetic Resonance Imaging at a Tertiary Care Center: A Comprehensive Analysis

Objectives: Cardiovascular magnetic resonance (CMR) is an advanced, non-invasive imaging modality with unparalleled accuracy for cardiac structure, function, and tissue characterization. Despite its global recognition, access and utilization remain uneven across regions, especially in developing countries. This study aimed to describe the clinical utility, diagnostic impact, and management implications of CMR at a tertiary care center in South India. Materials and Methods: This retrospective clinical audit analyzed 210 consecutive inpatients who underwent CMR between January 2021 and December 2023. Indications, final diagnoses, image quality, and impact on management were assessed. Results: Majority of the patients were aged 41–80 years, representing 160 (76%) individuals, with a male predominance of 128 (61%). The leading indications for CMR were viability assessment in 118 (56.2%), cardiomyopathy in 65 (31%), and myocarditis in 19 (9.0%) patients. The corresponding final diagnoses were ischemic cardiomyopathy (ICM)/coronary artery disease in 92 (43.80%) patients and non-ICM, including hypertrophic cardiomyopathy, in 65 (31%) patients. Image quality was diagnostic in 197 (94%) cine studies and 189 (90%) late gadolinium enhancement studies. CMR findings altered inpatient management through major medication changes in 94 (44.76%) patients and revascularization decisions in 88 (41.9%) patients. In addition, CMR results prompted device therapies in 34 (16.19%) patients and surgical or structural interventions in 18 (8.57%) patients. Anticoagulation therapy was initiated in 25 (11.90%) patients, and immunosuppression or anti-inflammatory therapy was started in 16 (7.62%) patients based on CMR findings. Conclusion: CMR is a robust and safe diagnostic tool with high image quality and significant clinical impact, improving decision-making in over half of the inpatients. This study represents one of the first systematic evaluations of real-world CMR practice from an Indian tertiary care setting, underscoring the need for broader accessibility and registry-based validation.