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Cardiac MRIs Are Becoming Safer for Patients with Implanted Devices
By Nancy Kennedy

Christopher E. PrayTwo new studies published in major medical journals challenge the long-held belief that people with pacemakers and other implanted cardiac devices (ICDs) cannot have magnetic resonance imaging (MRI) studies. The MRI is a valuable diagnostic tool that provides excellent images of internal organs and structures; they are widely used in every medical specialty and are considered safe for most people. The concern for people with ICDs has been that the magnetic force generated by the MRI device might cause their pacemakers or defibrillators to malfunction, leading to an arrhythmia (abnormal heartbeat) or shock, or that the wires contained in the ICDs could overheat, causing injury to the patient.

Christopher E. Pray, M.D., an expert in heart and cardiovascular system imaging at St. Clair Hospital in Mt. Lebanon, says that although the studies are promising, additional research on a much larger scale is necessary; he believes that it is too soon to change practices. "These studies are interesting and thought-provoking, but it is premature to view this as a major shift," he says. "Advances in technology are now producing pacemakers and other ICDs that are MRI-Compatible, and there are more advances on the horizon. In the future, it is likely that anyone with an ICD will be able to safely undergo MRI. But not yet."

Millions of Americans have pacemakers and implanted defibrillators. They act as a back-up if the heart fails, restoring a normal sinus rhythm, or regular heartbeat. The patients that participated in the two studies were carefully selected and supervised, and the MRI scanners were set at the lowest possible strength, of 1.5 Tesla, and were done on non-chest areas of the body. The studies reported no significant adverse outcomes during the MRI exams. 

Dr. Pray says that MRIs are so important and useful that they should be available to all patients. Those who have ICDs would probably benefit greatly from having an MRI. "An MRI is often essential to diagnosis and good patient care. The devices we are placing now are mostly MRI-compatible, so in the future these patients will be able to get MRI scans. But right now, there are many people with older model devices, which are not compatible. I scan patients with MRI-safe devices, but not with the older, non-safe ones that were used in these studies, for patient safety."

A new program in advanced cardiovascular imaging, directed by Dr. Pray, launched this summer at St. Clair. Dr. Pray has recently completed a fellowship in cardiac MRI and advanced imaging; prior to that, he completed a fellowship in cardiology and a residency in internal medicine. He is a graduate of the State University of New York School of Medicine. He met his wife, Nina Fatigati, M.D., during their residencies and relocated with her to Pittsburgh. She is a primary care physician in the South Hills; they live in Peters Township.

"Cardiac magnetic resonance imaging has revolutionized the field," he says. "We have the capacity to do stress tests in the MRI scanner; we use medication to raise the heart rate. The images are much more accurate; we can see blockages, and scars from previous heart attacks. MRI is the most accurate way to assess the size and function of the heart; it's the best way to diagnose treatable and sometimes reversible causes of heart failure. It is helpful in evaluating heart valve problems and we can also evaluate the great blood vessels including the aorta for aneurysms or dissections. I do MRI stress tests every day; they are becoming mainstream and they have many advantages for patients. With this diagnostic technology, we can make the diagnosis and manage the patient's heart disease very well."

Dr. Pray practices with South Hills Cardiology Associates, Bethel Park. He can be reached at 412-942-7900.

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