Cardiac MRI Across ESC Guidance in the Last Decade

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Tools

Background:

• Cardiovascular magnetic resonance (CMR) has evolved significantly in clinical practice.
• European Society of Cardiology (ESC) guidelines now recognize CMR as a foundational, first-line diagnostic test.

Purpose of the Study:

• To review the positioning and role of CMR within ESC guidelines and allied expert statements from 2015-2025.
• To highlight CMR's decision-shaping capabilities in cardiovascular diagnostics.

Main Methods:

• Structured narrative review of adult ESC clinical practice guidelines and expert statements (2015-2025).
• Identification of documents via society portals and PubMed, excluding pediatric guidance.
• Data extraction on clinical context, CMR role, and recommendation strength by independent reviewers.

Main Results:

• 13 ESC guidelines and 13 expert statements were identified, covering diverse cardiac conditions.
• CMR is increasingly favored (Class I/IIa, Level B/C) in situations where precise imaging impacts management.
• Expert statements standardize protocols and methods for consistent clinical application.

Conclusions:

• ESC guidelines have elevated CMR to a cornerstone of cardiovascular diagnostics.
• CMR's advanced imaging, including tissue characterization and quantification, resolves diagnostic uncertainty in conditions like MINOCA and cardiomyopathy.
• Expert statements provide a framework for integrating CMR into clinical pathways.