Background
Methods
Nr | Guideline keyword | Year of publication | Representation of CMR in the guideline | Class of recommendation | |||
---|---|---|---|---|---|---|---|
I | IIa | IIb | III | ||||
1 | Ventricular arrhythmias and sudden cardiac death [2] | 2022 | CMR mentioned in the guideline text and in 17 recommendations | 4 | 10 | 3 | 0 |
2 | Non-cardiac surgery: cardiovascular assessment [3] | 2022 | CMR mentioned in the guideline text and in 4 recommendations | 1 | 1 | 1 | 1 |
3 | Cardio-oncology [4] | 2022 | CMR mentioned in the guideline text and in 5 recommendations | 4 | 1 | 0 | 0 |
4 | Pulmonary hypertension [5] | 2022 | CMR mentioned in the guideline text and in 1 recommendation | 0 | 0 | 1 | 0 |
5 | Valvular heart disease [6] | 2021 | CMR mentioned in the guideline text | - | - | - | - |
6 | Prevention [7] | 2021 | CMR mentioned in the guideline text | - | - | - | - |
7 | Pacing [8] | 2021 | CMR mentioned in the guideline text and in 2 recommendations | 1 | 1 | 0 | 0 |
8 | Heart failure [9] | 2021 | CMR mentioned in the guideline text and in 4 recommendations | 2 | 1 | 1 | 0 |
9 | Sports [10] | 2020 | CMR mentioned in the guideline text and in 5 recommendations | 1 | 2 | 1 | 1 |
10 | NSTEMI [11] | 2020 | CMR mentioned in the guideline text and in 1 recommendation | 1 | 0 | 0 | 0 |
11 | Atrial fibrillation [12] | 2020 | CMR mentioned in the guideline text | – | – | – | – |
12 | Congenital heart disease [13] | 2020 | CMR mentioned in the guideline text and in 3 recommendations | 1 | 2 | 0 | 0 |
13 | Chronic coronary syndrome [14] | 2019 | CMR mentioned in the guideline text and in 10 recommendations | 4 | 1 | 3 | 2 |
14 | Diabetes [15] | 2019 | CMR mentioned in the guideline text and in 3 recommendations | 1 | 0 | 2 | 0 |
15 | Dyslipidaemias [16] | 2019 | CMR not mentioned in the guideline text | – | – | – | – |
16 | Pulmonary embolism [17] | 2019 | CMR mentioned in the guideline text and in 1 recommendation | 0 | 0 | 0 | 1 |
17 | Supraventricular tachycardia [18] | 2019 | CMR mentioned in the guideline text | – | – | – | – |
18 | Myocardial revascularization [19] | 2018 | CMR mentioned in the guideline text and in 4 recommendation | 0 | 1 | 3 | 0 |
19 | Arterial hypertension [20] | 2018 | CMR mentioned | – | – | – | – |
20 | Cardiovascular diseases in pregnancy [21] | 2018 | CMR mentioned in the guideline text and in 3 recommendations | 2 | 1 | 0 | 0 |
21 | Syncope [22] | 2018 | CMR mentioned in the guideline text | – | – | – | – |
22 | Peripheral artery disease [23] | 2017 | CMR mentioned in the guideline text and in 5 recommendations | 5 | 0 | 0 | 0 |
23 | STEMI [24] | 2017 | CMR mentioned in the guideline text and in 3 recommendations | 0 | 2 | 1 | 0 |
24 | Pericardial diseases [25] | 2015 | CMR mentioned in the guideline text and in 5 recommendations | 3 | 1 | 1 | 0 |
25 | Endocarditis [26] | 2015 | CMR mentioned in the guideline text | – | – | – | – |
26 | Hypertrophic cardiomyopathy [27] | 2014 | CMR mentioned in the guideline text and in 7 recommendations | 2 | 3 | 2 | 0 |
27 | Aortic diseases [28] | 2014 | CMR mentioned in the guideline text and in 9 recommendations | 8 | 1 | 0 | 0 |
Class of recommendation | Definition |
---|---|
I | Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective |
II | Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure |
IIa | Weight of evidence/opinion is in favor of usefulness/efficacy |
IIb | Usefulness/efficacy is less well established by evidence/opinion |
III | Evidence or general agreement that the given treatment or procedure is not useful/effective, and in some cases may be harmful |
Level of evidence | Definition |
---|---|
A | Data derived from multiple randomized clinical trials or meta-analyses |
B | Data derived from a single randomized clinical trial or large non-randomized studies |
C | Consensus of opinion of the experts and/ or small studies, retrospective studies, registries |
Results
Results across all guidelines
Results per individual guideline
2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death [2]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for evaluation of patients presenting with newly documented ventricular arrhythmia | ||
In patients with newly documented ventricular arrhythmia (frequent premature ventricular contractions (PVCs), non-sustained ventricular tachycardia (NSVT), sustained monomorphic ventricular tachycardia (SMVT) and suspicion of structural heart disease other than coronary artery disease after initial evaluation, a CMR should be considered | IIa | B |
Recommendations for evaluation of sudden cardiac arrest survivors | ||
Coronary imaging and CMR with LGE are recommended for evaluation of cardiac structure and function in all sudden cardiac arrest survivors without a clear underlying cause | I | B |
Recommendations for evaluation of relatives of sudden arrhythmic death syndrome decedents | ||
Ambulatory cardiac rhythm monitoring and CMR may be considered in relatives of sudden arrhythmic death syndrome (SADs) decedents | IIb | C |
Recommendations for the management of patients with idiopathic premature ventricular complexes/ventricular tachycardia | ||
In patients with PVCs / ventricular tachycardia (VT) and a presentation not typical for an idiopathic origin, CMR should be considered, despite a normal echocardiogram | IIa | C |
Recommendations for the management of patients with premature ventricular complex-induced or premature ventricular complex aggravated cardiomyopathy | ||
In patients with suspected PVCs- induced cardiomyopathy, CMR should be considered | IIa | B |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in dilated cardiomyopathy (DCM) / hypokinetic non-dilated cardiomyopathy (HNDCM) | ||
CMR with LGE should be considered in dilated cardiomyopathy (DCM) / hypokinetic non-dilated cardiomyopathy (HNDCM) patients for assessing the aetiology and the risk of ventricular arrhythmia (VA) / sudden cardiac death (SCD) | IIa | B |
ICD implantation should be considered in DCM / HNDCM patients with a LVEF < 50% and ≥ 2 risk factors (syncope, LGE on CMR, inducible sustained monomorphic VT (SMVT) at programmed electrical stimulation (PES), pathogenic mutations in LMNA, PLN, FLNC, and RBM 20 genes) | IIa | C |
Recommendations for diagnostic, risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy | ||
In patients with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), CMR is recommended | I | B |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in hypertrophic cardiomyopathy | ||
CMR with LGE is recommended in hypertrophic cardiomyopathy (HCM) patients for diagnostic work-up | I | B |
ICD implantation should be considered in HCM patients aged 16 years or more with an intermediate 5-year risk of SCD (≥ 4 to < 6%) and with (a) significant LGE at CMR (usually ≥ 15% of LV mass); or (b) LVEF < 50%; or (c) abnormal blood pressure response during exercise test; or (d) LV apical aneurysm; or (e) presence of sarcomeric pathogenic mutation | IIa | B |
ICD implantation may be considered in HCM patients aged 16 years or more with a low estimated 5-year risk of SCD (< 4%) and with (a) significant LGE at CMR (usually ≥ 15% of LV mass); or (b) LVEF < 50%; or (c) LV apical aneurysm | IIb | B |
Recommendations for implantable cardioverter defibrillator implantation in left ventricular non-compaction | ||
In patients with a left ventricular non-compaction (LVNC) cardiomyopathy phenotype based on CMR or echocardiography, implantation of an ICD for primary prevention of SCD should be considered to follow DCM / HNDCM recommendations | IIa | C |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in neuromuscular diseases | ||
Invasive electrophysiological evaluation should be considered in patients with myotonic dystrophy and a PR interval ≥ 240 ms or QRS duration ≥ 120 ms or who are older than 40 years and have supraventricular arrhythmias or who are older than 40 years and have significant LGE on CMR | IIa | B |
Implantation of an ICD may be considered in patients with Duchenne/Becker muscular dystrophy and significant LGE at CMR | IIb | C |
Recommendations for risk stratification, sudden cardiac death prevention, and treatment of ventricular arrhythmias in cardiac sarcoidosis | ||
In patients with cardiac sarcoidosis who have a LVEF > 35% but significant LGE at CMR after resolution of acute inflammation, ICD implantation should be considered | IIa | B |
In patients with cardiac sarcoidosis who have a LVEF 35–50% and minor LGE at CMR, after resolution of acute inflammation, programmed electrical stimulation (PES) for risk stratification should be considered | IIa | C |
Recommendations for risk stratification and prevention of sudden cardiac death in athletes | ||
In athletes with positive medical history, abnormal physical examination, or ECG alterations, further investigations including echocardiography and/or CMR to confirm (or exclude) an underlying disease are recommended | I | C |
CMR in the guideline text
Comparison between the current and the last guideline
2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery [3]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for stress imaging | ||
Stress imaging is recommended before high-risk elective non-cardiac surgery in patients with poor functional capacity and high likelihood of coronary artery disease or high clinical risk | I | B |
Stress imaging should be considered before high-risk non-cardiac surgery in asymptomatic patients with poor functional capacity, and previous percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) | IIa | C |
Stress imaging may be considered before intermediate-risk non-cardiac surgery when ischemia is of concern in patients with clinical risk factors and poor functional capacity | IIb | B |
Stress imaging is not recommended routinely before non-cardiac surgery | III | C |
CMR in the guideline text
Comparison between the current and the last guideline
2022 ESC Guidelines on cardio-oncology [4]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for cardiac imaging modalities in patients with cancer | ||
CMR should be considered for the assessment of cardiac function when echocardiography is unavailable or non-diagnostic | IIa | C |
Recommendations for the diagnosis and management of immune checkpoint inhibitor-associated myocarditis | ||
Cardiac Troponin (cTn), ECG, and cardiovascular imaging (echocardiography and CMR) are recommended to diagnose immune checkpoint inhibitor (ICI)—associated myocarditis | I | B |
Recommendations for the diagnosis and management of Takotsubo syndrome in patients with cancer | ||
CMR is recommended to exclude myocarditis and myocardial infarction | I | B |
Recommendations for the management of pericardial diseases in patients receiving anticancer treatment | ||
Multimodality cardiovascular imaging (echocardiography, CMR ± CT), ECG and measurement of cardiac biomarkers are recommended to confirm the diagnosis, assess the hemodynamic consequences of pericardial disease, and rule out associated myocarditis | I | C |
Recommendations for amyloid light-chain cardiac amyloidosis diagnosis and monitoring | ||
CMR is recommended in patients with suspected amyloid light-chain cardiac amyloidosis (AL-CA) | I | A |
CMR in the guideline text
Comparison between the current and the last guideline
2022ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension [5]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for screening and improved detection of pulmonary arterial hypertension and chronic thrombo-embolic pulmonary hypertension | ||
In symptomatic patients with systemic sclerosis, exercise echocardiography or cardiopulmonary exercise testing (CPET), or CMR may be considered to aid decisions to perform right heart catheterization | IIb | C |
CMR in the guideline text
Comparison between the current and the last guideline
2021 ESC/EACTS Guidelines for the management of valvular heart disease [6]
CMR in the guideline text
CMR in specific recommendations
Comparison between the current and the last guideline
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice [7]
CMR in specific recommendations
CMR in the guideline text
Comparison between the current and the last guideline
2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy [8]
CMR in the guideline text
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations regarding imaging before implantation | ||
Cardiac imaging is recommended in patients with suspected or documented symptomatic bradycardia to evaluate the presence of structural heart disease, to determine LV systolic function, and to diagnose potential causes of conduction disturbances | I | C |
Multimodality imaging (CMR, CT, PET) should be considered for myocardial tissue characterization in the diagnosis of specific pathologies associated with conduction abnormalities needing pacemaker implantation, particularly in patients younger than 60 years | IIa | C |
Comparison between the current and the last guideline
2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [9]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for specialized diagnostic tests for selected patients with chronic heart failure to detect reversible/treatable causes of heart failure | ||
CMR is recommended for the assessment of myocardial structure and function in those with poor echocardiogram acoustic windows | I | C |
CMR is recommended for the characterization of myocardial tissue in suspected infiltrative disease, Fabry disease, inflammatory disease (myocarditis), left ventricular non-compaction, amyloid, sarcoidosis, iron overload / haemochromatosis | I | C |
CMR with LGE should be considered in dilated cardiomyopathy (DCM) to distinguish between ischemic and non-ischemic myocardial damage | IIa | C |
Non-invasive stress imaging (CMR, stress echocardiography, SPECT, PET) may be considered for the assessment of myocardial ischemia and viability in patients with coronary artery disease (CAD) who are considered suitable for coronary revascularization | IIb | B |
CMR in the guideline text
Comparison between the current and the last guideline
2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease [10]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for exercise and participation in sports in individuals with aortic pathology | ||
Prior to engaging in exercise, risk stratification, with careful assessment including advanced imaging of the aorta (CT/CMR) and exercise testing with blood pressure assessment is recommended | I | C |
Recommendations for exercise in individuals with left ventricular non-compaction cardiomyopathy (LVNC) | ||
A diagnosis of LVNC in athletic individuals should be considered if they fulfill imaging criteria, in association with cardiac symptoms, family history of LVNC or cardiomyopathy, left ventricular systolic (EF < 50%) or diastolic (E’ < 9 cm/s) dysfunction, a thin compacted epicardial layer (< 5 mm in end-diastole on CMR, or < 8 mm in systole on echocardiography), or abnormal 12-lead ECG | IIa | B |
Recommendations for exercise in individuals with dilated cardiomyopathy (DCM) | ||
Participation in high- or very high-intensity exercise including competitive sports (with the exception of those where occurrence of syncope may be associated with harm or death) may be considered in asymptomatic individuals who fulfill all of the following: (i) mildly reduced left ventricular systolic function (EF 45–50%); (ii) absence of frequent and/or complex ventricular arrhythmias on ambulatory Holter monitoring or exercise testing; (iii) absence of LGE on CMR; (iv) ability to increase EF by 10–15% during exercise; and (v) no evidence of high-risk genotype (lamin A/C or filamin C) | IIb | C |
Participation in high- or very high-intensity exercise including competitive sports is not recommended for individuals with a DCM and any of the following: (i) symptoms or history of cardiac arrest or unexplained syncope; (ii) LVEF < 45%; (iii) frequent and/or complex ventricular arrhythmias on ambulatory Holter monitoring or exercise testing; (iv) extensive LGE (> 20%) on CMR; or (v) high-risk genotype (lamin A/C or filamin C) | III | C |
Recommendations for exercise in individuals with myocarditis | ||
Return to all forms of exercise including competitive sports should be considered after 3–6 months in asymptomatic individuals, with normal troponin and biomarkers of inflammation, normal LV systolic function on echocardiography and CMR, no evidence of ongoing inflammation or myocardial fibrosis on CMR, good functional capacity, and absence of frequent and/or complex ventricular arrhythmias on ambulatory Holter monitoring or exercise testing | IIa | C |
CMR in the guideline text
Comparison between the current and the last guideline
2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation [11]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for myocardial infarction with non-obstructive coronary arteries (MINOCA) | ||
It is recommended to perform CMR in all MINOCA patients without an obvious underlying cause | I | B |
CMR in the guideline text
Comparison between the current and the last guideline
2020 ESC Guidelines for the diagnosis and management of atrial fibrillation [12]
CMR in specific recommendations
CMR in the guideline text
Comparison between the current and the last guidelines
2020 ESC Guidelines for the management of adult congenital heart disease [13]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for intervention after repair of tetralogy of Fallot (TOF) | ||
Electrophysiologic evaluation, including programmed electrical stimulation, should be considered for risk stratification for sudden cardiac death (SCD) in patients with additional risk factors (LV/RV dysfunction; non-sustained, symptomatic ventricular tachycardia (VT); QRS duration ≥ 180 ms, extensive RV scarring on CMR) | IIa | C |
ICD implantation should be considered in selected TOF patients with multiple risk factors for SCD, including LV dysfunction, non-sustained, symptomatic VT, QRS duration ≥ 180 ms, extensive RV scarring on CMR, or inducible VT at programmed electrical stimulation | IIa | C |
Recommendations for the management of patients with anomalous coronary arteries | ||
Non-pharmacological functional imaging (e.g. nuclear study, echocardiography, or CMR with physical stress) is recommended in patients with coronary anomalies to confirm/exclude myocardial ischemia | I | C |
CMR in the guideline text
Comparison between the current and the last guideline
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes [14]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
CMR in the initial diagnostic management of patients with suspected coronary artery disease (CAD) | ||
CMR may be considered in patients with an inconclusive echocardiographic test | IIb | C |
Use of diagnostic imaging tests in the initial diagnostic management of symptomatic patients with suspected CAD | ||
Non-invasive functional imaging for myocardial ischemia or coronary CTA is recommended as the initial test for diagnosing CAD in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone | I | B |
It is recommended that selection of the initial non-invasive diagnostic test is done based on the clinical likelihood of CAD and other patient characteristics that influence test performance, local expertise, and the availability of tests | I | C |
Functional imaging for myocardial ischemia is recommended if coronary CTA has shown CAD of uncertain functional significance or is not diagnostic | I | B |
Recommendations on risk assessment | ||
Risk stratification, preferably using stress imaging or coronary CTA (if local expertise and availability permit), or alternatively exercise stress ECG (if significant exercise can be performed and the ECG is amenable to the identification of ischemic changes), is recommended in patients with suspected or newly diagnosed CAD | I | B |
Recommendations for screening for coronary artery disease in asymptomatic subjects | ||
In high-risk asymptomatic adults (with diabetes, a strong family history of CAD, or when previous risk-assessment tests suggest a high risk of CAD), functional imaging or coronary CTA may be considered for cardiovascular risk assessment | IIb | C |
In low-risk non-diabetic asymptomatic adults, coronary CTA or functional imaging for ischemia is not indicated for further diagnostic assessment | III | C |
In asymptomatic adults (age > 40 years) with diabetes, functional imaging or coronary CTA may be considered for advanced cardiovascular risk assessment | IIb | B |
Recommendations for symptomatic patients with a long-standing diagnosis of chronic coronary syndromes | ||
Risk stratification is recommended in patients with new or worsening symptom levels, preferably using stress imaging or, alternatively, exercise stress ECG | I | B |
Investigations in patients with suspected coronary microvascular angina | ||
Transthoracic Doppler of the LAD, CMR, and PET may be considered for non-invasive assessment of coronary flow reserve (CFR) | IIb | B |
CMR in the guideline text
Comparison between the current and the last guideline
2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD [15]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for the use of imaging testing for cardiovascular risk assessment in asymptomatic patients with diabetes | ||
CT coronary angiography (CTCA) or functional imaging (radionuclide myocardial perfusion imaging, stress CMR imaging, or exercise or pharmacological stress echocardiography) may be considered in asymptomatic patients with diabetes mellitus (DM) for screening of coronary artery disease (CAD) | IIb | B |
Detection of atherosclerotic plaque of carotid or femoral arteries by CT, or magnetic resonance imaging, may be considered as a risk modifier in patients with DM at moderate or high risk | IIb | B |
Recommendations for the diagnosis and management of peripheral arterial disease in patients with diabetes | ||
CT angiography or magnetic resonance angiography is indicated in case of lower extremity arterial disease when revascularization is considered | I | C |
CMR in the guideline text
Comparison between the current and the last guideline
2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk [16]
2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism [17]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for diagnosis | ||
Magnetic resonance angiography is not recommended for ruling out pulmonary embolism | III | A |
CMR in the guideline text
Comparison between the current and the last guideline
2019 ESC Guidelines for the management of patients with supraventricular tachycardia [18]
CMR in specific recommendations
CMR in the guideline text
Comparison between the current and the last guideline
2018 ESC/EACTS Guidelines on myocardial revascularization [19]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for non-invasive imaging in patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction | ||
Non-invasive stress imaging (CMR, stress echocardiography, SPECT, or PET) may be considered for the assessment of myocardial ischemia and viability in patients with heart failure and CAD (considered suitable for coronary revascularization) before the decision on revascularization | IIb | B |
Strategies for follow-up and management in symptomatic patients after myocardial revascularization | ||
An imaging stress test should be considered in patients with prior revascularization over stress ECG | IIa | B |
Strategies for follow-up and management in asymptomatic patients after myocardial revascularization | ||
Surveillance by non-invasive imaging-based stress testing may be considered in high-risk patient subsets 6 months after revascularization | IIb | C |
Routine non-invasive imaging-based stress testing may be considered 1 year after PCI and > 5 years after CABG | IIb | C |
CMR in the guideline text
Comparison between the current and the last guideline
2018 ESC/ESH Guidelines for the management of arterial hypertension [20]
CMR in specific recommendations
CMR in the guideline text
Comparison between the current and the last guideline
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy [21]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
General recommendations | ||
MRI (without gadolinium) should be considered if echocardiography is insufficient for a definite diagnosis | IIa | C |
Recommendations for the management of aortic disease | ||
Imaging of the entire aorta (CT/MRI) is recommended before pregnancy in patients with a genetically proven aortic syndrome or known aortic disease | I | C |
For imaging of pregnant women with dilatation of the distal ascending aorta, aortic arch, or descending aorta, MRI (without gadolinium) is recommended | I | C |
CMR in the guideline text
Comparison between the current and the last guideline
2018 ESC Guidelines for the diagnosis and management of syncope [22]
CMR in specific recommendations
CMR in the guideline text
Comparison between the current and the last guideline
2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases [23]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for imaging of extracranial carotid arteries | ||
Duplex ultrasound (as first-line imaging), CTA and/or MRA are recommended for evaluating the extent and severity of extracranial carotid stenoses | I | B |
When carotid artery stenosis (CAS) is being considered, it is recommended that any duplex ultrasound study be followed by either MRA or CTA to evaluate the aortic arch as well as the extra- and intracranial circulation | I | B |
When carotid endarterectomy (CEA) is considered, it is recommended that the duplex ultrasound stenosis estimation be corroborated by either MRA or CTA (or by a repeat duplex ultrasound study performed in an expert vascular laboratory) | I | B |
Recommendations for diagnostic strategies for renal artery disease | ||
Duplex ultrasound (as first-line), CTA and MRA are recommended imaging modalities to establish a diagnosis of renal artery disease | I | B |
Recommendations on imaging in patients with lower extremity artery disease | ||
Duplex ultrasound and/or CTA and/or MRA are indicated for anatomical characterization of lower extremity artery disease lesions and guidance for optimal revascularization strategy | I | C |
CMR in the guideline text
Comparison between the current and the last guideline
2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation [24]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Indications for imaging and stress testing in STEMI patients: during hospital stay (after primary PCI) | ||
When echocardiography is suboptimal/inconclusive, an alternative imaging method (CMR preferably) should be considered | IIa | C |
Either stress echo, CMR, SPECT, or PET may be used to assess myocardial ischemia and viability, including in multivessel CAD | IIb | C |
Indications for imaging and stress testing in STEMI patients: after discharge | ||
When echo is suboptimal or inconclusive, alternative imaging methods (CMR preferably) should be considered to assess LV function | IIa | C |
CMR in the guideline text
Comparison between the current and the last guideline
2015 ESC Guidelines for the diagnosis and management of pericardial diseases [25]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for the diagnosis and management of pericarditis associated with myocarditis | ||
Cardiac magnetic resonance is recommended for the confirmation of myocardial involvement | I | C |
Recommendations for the diagnosis of pericardial effusion | ||
CT or CMR should be considered in suspected cases of loculated pericardial effusion, pericardial thickening, and masses, as well as associated chest abnormalities | IIa | C |
Recommendations for the diagnosis of constrictive pericarditis | ||
CT and/or CMR are indicated as second-level imaging techniques to assess calcifications (CT), pericardial thickness, degree, and extension of pericardial involvement | I | C |
Recommendations for therapy of constrictive pericarditis | ||
Empiric anti-inflammatory therapy may be considered in cases with transient or new diagnosis of constriction with concomitant evidence of pericardial inflammation (i.e. CRP elevation or pericardial enhancement on CT/CMR) | IIb | C |
Recommendations for the general diagnostic work-up of pericardial diseases | ||
CT and/or CMR are recommended as second-level testing for diagnostic workup in pericarditis | I | C |
CMR in the guideline text
Comparison between the current and the last guideline
2015 ESC Guidelines for the management of infective endocarditis [26]
CMR in specific recommendations
CMR in the guideline text
Comparison between the current and the last guideline
2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy [27]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations for cardiovascular magnetic resonance evaluation in hypertrophic cardiomyopathy (HCM) | ||
It is recommended that CMR studies be performed and interpreted by teams experienced in cardiac imaging and in the evaluation of heart muscle disease | I | C |
In the absence of contraindications, CMR with LGE is recommended in patients with suspected HCM who have inadequate echocardiographic windows, in order to confirm the diagnosis | I | B |
In the absence of contraindications, CMR with LGE should be considered in patients fulfilling diagnostic criteria for HCM, to assess cardiac anatomy, ventricular function, and the presence and extent of myocardial fibrosis | IIa | B |
CMR with LGE imaging should be considered in patients with suspected apical hypertrophy or aneurysm | IIa | C |
CMR with LGE imaging should be considered in patients with suspected cardiac amyloidosis | IIa | C |
CMR with LGE may be considered before septal alcohol ablation or myectomy, to assess the extent and distribution of hypertrophy and myocardial fibrosis | IIb | C |
Recommendations on routine follow-up | ||
CMR may be considered every 5 years in clinically stable patients, or every 2–3 years in patients with progressive disease | IIb | C |
CMR in the guideline text
Comparison between the current and the last guideline
2014 ESC Guidelines on the diagnosis and treatment of aortic diseases [28]
CMR in specific recommendations
Recommendation | Class | Level |
---|---|---|
Recommendations on diagnostic work-up of acute aortic syndrome | ||
In stable patients with a suspicion of acute aortic syndrome (AAS), the following imaging modalities are recommended (or should be considered) according to local availability and expertise: CT (1C), MRI (1C), TOE (IIa C) | I | C |
In case of initially negative imaging with persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended | I | C |
In case of uncomplicated Type B aortic dissection (AD) treated medically, repeated imaging (CT or MRI) during the first days is recommended | I | C |
Recommendations on the management of intramural haematoma | ||
In uncomplicated Type B intramural hematoma (IMH), repetitive imaging (MRI or CT) is indicated | I | C |
Recommendations on management of penetrating aortic ulcer | ||
In uncomplicated Type B penetrating aortic ulcer (PAU), repetitive imaging (MRI or CT) is indicated | I | C |
Recommendations for the management of aortic root dilation in patients with bicuspid aortic valve | ||
Cardiac MRI or CT is indicated in patients with bicuspid aortic valve (BAV) when the morphology of the aortic root and the ascending aorta cannot be accurately assessed by TTE | I | C |
In the case of aortic diameter > 50 mm or an increase > 3 mm/year measured by echocardiography, confirmation of the measurement is indicated, using another imaging modality (CT or MRI) | I | C |
Recommendations for follow-up and management of chronic aortic diseases | ||
Contrast CT or MRI is recommended, to confirm the diagnosis of chronic aortic dissection | I | C |
For follow-up after (T)EVAR in young patients, MRI should be preferred to CT for magnetic resonance compatible stent grafts, to reduce radiation exposure | IIa | C |