FAST-HF CMR: A Vendor-Neutral 10-Minute Protocol Reduces Scan Time, Improves Access, and Preserves Diagnostic Yield in a High-Throughput Heart Failure Program

Background: Long CMR protocols contribute to access bottlenecks and long waiting lists. Dark-blood late gadolinium enhancement (LGE) improves scar conspicuity, while native T1 mapping provides contrast-free tissue characterization. We implemented a focused FAST-HF CMR (~10 min) for common clinical questions (ischemic vs. non-ischemic scar; myocarditis/infiltrative suspicion).

Methods: We performed a pre–post implementation study.

• Pre (standard protocol): full cine stack, bright-blood LGE, multiparametric mapping.


• Post (FAST-HF): single-shot cine stack, dark-blood PSIR-LGE, native T1; optional T2 if edema suspected.

Primary endpoints: scan time, weekly throughput, and waiting list.
Secondary endpoints: nondiagnostic rate, diagnostic agreement (subset double-scanned), and management changes within 30 days.

Results: Across 24 weeks (12 pre, 12 post):

• Median scan time fell from 42 [IQR 38–47] to 12 [10–14] min (p< 0.001).


• Weekly completions rose from 21 to 34 scans/week (+62%, p< 0.001).


• Median waiting time decreased from 41 to 19 days (p< 0.01).

Diagnostic yield:

• Agreement with full protocol for infarct presence/extent and non-ischemic scar = κ=0.91.


• Nondiagnostic rate remained stable (2.1% vs 2.5%, p=0.79).


• Management changes occurred in 29% post-FAST-HF (initiation of GDMT, ischemic triage).


• No increase in recall scans.

Conclusion: A streamlined FAST-HF CMR pathway reduced scan times by ~70%, doubled weekly throughput, and cut waiting lists in half, without compromising diagnostic confidence. This model demonstrates how simple protocol redesign can address global challenges of access, sustainability, and equity in advanced cardiac imaging.

Table 1. Performance of Standard vs. FAST-HF CMR Protocol (Nf660 Scans).

Domain	Metric	Standard Protocol (n=252)	FAST-HF Protocol (n=408)	p-value
Workflow Efficiency	Median scan time (min)	42 (IQR 38–47)	12 (IQR 10–14)	< 0.001
	Weekly scans completed	21 ± 4	34 ± 5	< 0.001
	Waiting list (days)	41 (32–51)	19 (14–27)	0.002
Diagnostic Reliability	Nondiagnostic rate (%)	2.1	2.5	0.79
	Diagnostic agreement (κ)	Reference	0.91	—
Clinical Impact	Management changes (%)	18	29	0.04
	Recall scans	Baseline	No increase	—

Figure 1: FAST-HF improves Efficiency While Maintaining Diagnostic Yield. Panel A: Median scan time fell (42 → 12 min) and waiting list shortened (41 → 19 days). Panel B: Weekly scan volume clearly rises after FAST-HF launch (week 12), with an annotated “FAST-HF start” marker. Diagnostic agreement κ=0.91, nondiagnostic rate unchanged.