Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques

Table 1 European Society of Cardiology and American College of Cardiology Foundation/American Heart Association Recommendations for cardiovascular magnetic resonance in stable coronary artery disease

ESC guidelines
Suspected/stable coronary artery disease[6]
In patients with suspected stable coronary artery disease and pretest probability of 15%-85% stress imaging is preferred as the initial test option if local expertise and availability permit	Class I
An imaging stress test is recommended in patients with resting ECG abnormalities, which prevent accurate interpretation of ECG changes during stress	Class I
CMR should be considered in symptomatic patients with prior revascularisation (PCI or CABG)	Class IIa
Risk stratification is recommended based on clinical assessment and the results of the stress test initially employed for making a diagnosis of stable coronary artery disease	Class I
CMR is recommended in the presence of recurrent or new symptoms once instability has been ruled out	Class I
In symptomatic patients with revascularised stable coronary artery disease, CMR is indicated rather than stress ECG	Class I
CMR is recommended for risk stratification in patients with known stable coronary artery disease and a deterioration in symptoms if the site and extent of ischemia would influence clinical decision making Recommendations for imaging to determine ischemia to plan revascularisation[6,144]	Class I
An imaging stress test should be considered to assess the functional severity of intermediate lesions on coronary arteriography	Class IIa
To achieve a prognostic benefit by revascularisation in patients with coronary artery disease, ischemia has to be documented by non-invasive imaging	Class I
Following MI with multivessel disease, or in whom revascularisation of other vessels is considered, CMR for ischaemia and viability is indicated before or after discharge	Class I
Heart failure[8]
CMR should be considered in patients with HF thought to have CAD, and who are considered suitable for coronary revascularization, to determine whether there is reversible myocardial ischaemia and viable myocardium	Class IIa
AHA guidelines
Diagnosis and management of stable coronary artery disease[7]
CMR can be used for patients with an intermediate (10%-90%) to high (> 90%) pretest probability of obstructive IHD who have an uninterpretable ECG and at least moderate physical functioning or no disabling comorbidity	Class IIa
CMR is reasonable for patients with an intermediate to high pretest probability of IHD who are incapable of at least moderate physical functioning or have disabling comorbidity	Class IIa
Pharmacological stress CMR is reasonable for risk assessment in patients with SIHD who are unable to exercise to an adequate workload regardless of interpretability of ECG	Class IIa
CMR is reasonable in patients with known SIHD who have new or worsening symptoms (not unstable) and who are incapable of at least moderate physical functioning or have disabling comorbidity	Class IIa

ESC: European Society of Cardiology; CMR: Cardiovascular magnetic resonance; ECG: Electrocardiogram; CABG: Coronary artery bypass graft; PCI: Percutaneous coronary intervention; AHA: American Heart Association; IHD: Ischemic heart disease; SIHD: Stable ischemic heart disease.