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Updated: Feb 22, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines
Florian von Knobelsdorff-Brenkenhoff1,2,3, Guenter Pilz4, Jeanette Schulz-Menger5,6
1Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University Munich, Norbert-Kerkel-Platz, 83734, Hausham, Germany. florian.vonknobelsdorff@khagatharied.de.
Insights
Cardiovascular magnetic resonance (CMR) is included in many American Heart Association/American College of Cardiology guidelines, but less frequently than in European guidelines, especially for coronary artery disease.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Guidelines
Background:
- Cardiovascular magnetic resonance (CMR) has growing evidence supporting its diagnostic value.
- Clinical utilization of CMR varies globally.
- Previous studies showed CMR is present in most European Society of Cardiology (ESC) guidelines.
Purpose of the Study:
- To analyze the role and representation of CMR in American College of Cardiology (ACC) and American Heart Association (AHA) guidelines.
- To identify the gap between CMR evidence and clinical practice within AHA/ACC guidelines.
Main Methods:
- Screened 24 AHA/ACC guidelines published between 2006 and 2017.
- Searched for terms including "magnetic resonance imaging" (MRI) and "cardiovascular magnetic resonance" (CMR).
- Extracted CMR-specific recommendations, including evidence levels and recommendation classes.
Main Results:
- CMR was mentioned in 50% of AHA/ACC guidelines, with 65 specific recommendations.
- Most recommendations had evidence level C (67.7%) or B (32.3%), with no level A.
- Recommendations covered vascular imaging, congenital heart disease, cardiomyopathies, and stress testing.
Conclusions:
- CMR is featured in two-thirds of AHA/ACC guidelines with several specific recommendations.
- CMR representation in AHA/ACC guidelines is lower compared to ESC guidelines, particularly for coronary artery disease.
Background:
Whereas evidence supporting the diagnostic value of cardiovascular magnetic resonance (CMR) has increased, there exists significant worldwide variability in the clinical utilization of CMR. A recent study demonstrated that CMR is represented in the majority of European Society for Cardiology (ESC) guidelines, with a large number of specific recommendations in particular regarding coronary artery disease. To further investigate the gap between the evidence and clinical use of CMR, this study analyzed the role of CMR in the guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA).
Methods:
Twenty-four AHA/ACC original guidelines, updates and new editions, published between 2006 and 2017, were screened for the terms "magnetic", "MRI", "CMR", "MR" and "imaging". Non-cardiovascular MR examinations were excluded. All CMR-related paragraphs and specific recommendations for CMR including the level of evidence (A, B, C) and the class of recommendation (I, IIa, IIb, III) were extracted.
Results:
Twelve of the 24 guidelines (50.0%) contain specific recommendations regarding CMR. Four guidelines (16.7%) mention CMR in the text only, and 8 (33.3%) do not mention CMR. The 12 guidelines with recommendations for CMR contain in total 65 specific recommendations (31 class-I, 23 class-IIa, 6 class-IIb, 5 class-III). Most recommendations have evidence level C (44/65; 67.7%), followed by level B (21/65; 32.3%). There are no level A recommendations. 22/65 recommendations refer to vascular imaging, 17 to congenital heart disease, 8 to cardiomyopathies, 8 to myocardial stress testing, 5 to left and right ventricular function, 3 to viability, and 2 to valvular heart disease.
Conclusions:
CMR is represented in two thirds of the AHA/ACC guidelines, which contain a number of specific recommendations for the use of CMR. In a simplified comparison with the ESC guidelines, CMR is less represented in the AHA/ACC guidelines in particular in the field of coronary artery disease.
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