Improving efficiency of cardiac magnetic resonance imaging for children with pulmonary hypertension

Abstract Background Right ventricular (RV) failure is an important cause of morbidity and mortality in pulmonary hypertension (PH). However, access to pediatric CMR – the gold standard for RV assessment – can be limited by sedation needs, tolerance of prolonged exams, and intravenous access for contrast. We hypothesize that a focused PH-specific CMR protocol could address these limitations and standardize image acquisition at our institution. Methods We performed a retrospective (1/2018-12/2025) single-center study of pediatric PH patients referred for CMR. Patient and CMR characteristics were collected via chart review. A PH CMR protocol was implemented in late 2022 with additional clinician education in 1/2024. Outcomes were compared across three eras: pre-protocol implementation (era 1), post-protocol implementation (era 2), and after additional clinical education (era 3). Results We identified 129 CMR examinations in 57 PH patients (era 1: ~10 exams/year, era 2: 28 exams/year, era 3: ~26 exams/year). Despite increasing patient complexity and center volume, exam duration decreased after protocol implementation (era 1: 40 minutes [IQR 33–50] vs. era 3: 32 minutes [IQR 27–36], p = 0.003), reflecting shortened first-time CMR duration and decreased number of extraneous sequences. Contrast administration decreased (era 1: 26/48 [54.2%] vs. era 3:16/53 [30.2%], p = 0.007) but anesthesia use remained consistent across eras. Conclusions A focused PH CMR protocol was associated with shorter exam duration, improved image acquisition standardization, and reduced contrast administration despite increasing patient complexity and center volume. These findings support indication-specific CMR protocols in pediatric PH. Follow-up is needed to determine whether focused protocols reduce anesthesia use in younger children.