Introduction
Methods
Definition of cardiac MR
Rating system
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Score 7–9: Appropriate test for the specific indication. Test is generally acceptable and a reasonable approach for the listed indication.
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Score 4–6: Uncertain for specific indication. Test may be generally acceptable and may be a reasonable approach for the indication. Uncertainty also implies that more research or patient information or both are needed to classify the indication definitively.
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Score 1–3: Inappropriate test for specific indication. Test is not generally acceptable and is not a reasonable approach for the indication.
Results
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Evaluation of chest pain syndrome
| |||
1 | Low pre-test probability of CAD | I (2) | Highly agreed |
ACCF indication no. 1 | |||
ECG interpretable AND able to exercise | |||
2 | Intermediate pre-test probability of CAD | U (4) | ACCF indication no. 2 |
ECG interpretable AND able to exercise | |||
ASCI CT indication no. 1 | |||
3 | Intermediate pre-test probability of CAD | A (7) | ACCF indication no. 3 |
ECG uninterpretable OR unable to exercise | |||
ASCI CT indication no. 2 | |||
4 | High pre-test probability of CAD | U (6) | ACCF indication no. 4 |
ASCI CT indication no. 3 | |||
Evaluation of intra-cardiac structures
| |||
5 | Evaluation of suspected coronary anomalies | A (8) | Highly agreed |
ACCF indication no. 8 | |||
ASCI CT indication no. 4 | |||
Acute chest pain
| |||
6 | Low pre-test probability of CAD | U (4) | ASCI CT indication no. 5 |
No ECG changes and serial enzymes negative | |||
7 | Intermediate pre-test probability of CAD | U (5) | ACCF indication no. 9 |
No ECG changes and serial enzymes negative | |||
ASCI CT indication no. 6 | |||
8 | High pre-test probability of CAD | U (5) | ASCI CT indication no. 7 |
No ECG changes and serial enzymes negative | |||
9 | High pre-test probability of CAD | I (2) | ACCF indication no. 10 |
ECG—ST-segment elevation and/or positive cardiac enzymes | |||
ASCI CT indication no. 8 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Asymptomatic
| |||
10 | Low CHD risk (Framingham risk criteria) | I (1) | Highly agreed |
ASCI CT indication no. 10 | |||
11 | Moderate CHD risk (Framingham) | U (4) | ASCI CT indication no. 11 |
12 | High CHD risk (Framingham) | U (6) | ASCI CT indication no. 12 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Asymptomatic (use of coronary MRA)
| |||
13 | Low CHD risk (Framingham) | I (3) | Highly agreed |
14 | Moderate CHD risk (Framingham) | I (3) | |
15 | High CHD risk (Framingham) | U (5) |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Evaluation of chest pain syndrome
| |||
16 | Uninterpretable or equivocal stress test (exercise, perfusion, or stress echo) | A (8) | Highly agreed |
ASCI CT indication no. 16 | |||
17 | Evidence of moderate to severe ischemia on stress test (exercise, perfusion, or stress echo) | U (5) | ASCI CT indication no. 17 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Asymptomatic
| |||
18 | Normal prior stress test (exercise, nuclear, echo, MRI) | I (3) | ACCF indication no. 11 |
High CHD risk (Framingham) | |||
19 | Equivocal stress test (exercise, stress SPECT, or stress echo) | U (6) | ACCF indication no. 12 |
Intermediate CHD risk (Framingham) | |||
20 | Coronary angiography (catheterization or CT) | A (7) | ACCF indication no. 13 |
Stenosis of unclear significance |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Asymptomatic
| |||
21 | No previous definitive test (invasive angiography, MRCA or CTCA) available | U (5) | Asian characteristic indication |
ASCI CT indication no. 21 | |||
22 | Previous tests (invasive angiography, CMR or CCT) documented coronary aneurysm/stenosis, for follow up | A (7) | Highly agreed |
Asian characteristic indication | |||
ASCI CT indication no. 22 | |||
Symptomatic
| |||
23 | No previous definitive test (invasive angiography, MRCA or CTCA) available | A (7) | Asian characteristic indication |
ASCI CT indication no. 23 | |||
24 | Previous tests (angiography, CMR or CCT) documented coronary aneurysm/stenosis, for follow up | A (7) | Asian characteristic indication |
ASCI CT indication no. 24 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Low-risk surgery
| |||
25 | Intermediate perioperative risk | I (3) | ACCF indication no. 14 |
ASCI CT indication no. 25 | |||
Intermediate- or high-risk surgery
| |||
26 | Intermediate perioperative risk | U (5) | ACCF indication no. 15 |
ASCI CT indication no. 26 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Preoperative evaluation
| |||
27 | Use of MRI for CAD evaluation before valve surgery | U (6) | JCCT 2009 proposed indication |
ASCI CT indication no. 27 | |||
28 | Anatomic assessment before percutaneous device closure of ASD or VSD or percutaneous aortic valve replacement | A (7) | JCCT 2009 proposed indication |
ASCI CT indication no. 28 | |||
29 | Evaluation of complex lesions before PCI (i.e., chronic total occlusions, bifurcation lesions) | U (5) | JCCT 2009 proposed indication |
ASCI CT indication no. 29 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Evaluation of chest pain syndrome
| |||
30 | Evaluation of bypass grafts and coronary anatomy | U (5) | ACCF indication no. 16 |
ASCI CT indication no. 30 | |||
31 | History of percutaneous revascularization with stents | U (4) | ACCF indication no. 17 |
ASCI CT indication no. 31 | |||
Asymptomatic
| |||
32 | Evaluation of bypass grafts and coronary anatomy | U (4) | ASCI CT indication no. 32 |
Less than 5 years after CABG | |||
33 | Evaluation of bypass grafts and coronary anatomy | U (4) | ASCI CT indication no. 33 |
Greater than or equal to 5 years after CABG | |||
34 | Evaluation for in-stent restenosis and coronary anatomy after PCI | I (3) | ASCI CT indication no. 34 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Morphology
| |||
35 | Assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves | A (8) | Highly agreed |
ACCF indication no. 18 | |||
ASCI CT indication no. 35 | |||
36 | Assessment of post-operative congenital heart disease, such as residual pulmonary stenosis, ventricular septal defect and patency check for Blalock-Taussig shunt | A (8) | Highly agreed |
ASCI CT indication no. 36 | |||
Asian characteristic indication | |||
37 | Evaluation in patients with new onset heart failure to assess etiology | A (8) | Highly agreed |
ASCI CT indication no. 37 | |||
Evaluation of ventricular and valvular function
| |||
38 | Evaluation of LV function following myocardial infarction OR in heart failure patients | A (8) | Highly agreed |
ACCF indication no. 19 | |||
39 | Evaluation of LV function following myocardial infarction OR in heart failure patients | A (9) | Highly agreed |
ACCF indication no. 20 | |||
Patients with technically limited images from echocardiogram | |||
40 | Quantification of LV function | A(9) | Highly agreed |
Discordant information that is clinically significant from prior tests | ACCF indication no. 21 | ||
41 | Evaluation of specific cardiomyopathies (infiltrative [amyloid, sarcoid], HCM, or due to cardiotoxic therapies) | A(9) | Highly agreed |
ACCF indication no. 22 | |||
42 | Characterization of native and prosthetic cardiac valves | A (7) | Highly agreed |
Patients with technically limited images from echocardiogram or TEE | ACCF indication no. 23 | ||
43 | Evaluation for arrhythmogenic right ventricular cardiomyopathy (ARVC) | A (8) | Highly agreed |
ACCF indication no. 24 | |||
Patients presenting with syncope or ventricular arrhythmia | |||
44 | Evaluation of myocarditis or myocardial infarction with normal coronary arteries | A(9) | Highly agreed |
ACCF indication no. 25 | |||
Positive cardiac enzymes without obstructive atherosclerosis on angiography | |||
Evaluation of intra- and extra-cardiac structures
| |||
45 | Evaluation of cardiac mass (suspected tumor or thrombus) | A (9) | Highly agreed |
Patients with technically limited images from echocardiogram or TEE | ACCF indication no. 26 | ||
ASCI CT indication no. 42 | |||
46 | Evaluation of pericardial conditions (pericardial mass, constrictive pericarditis, or complications of cardiac surgery) | A (8) | Highly agreed |
Patients with technically limited images from echocardiogram or TEE | |||
ACCF indication no. 27 | |||
ASCI CT indication no. 43 | |||
47 | Evaluation of pulmonary vein anatomy prior to invasive radiofrequency ablation for atrial fibrillation | A (7) | Highly agreed |
ACCF indication no. 29 | |||
Left atrial and pulmonary venous anatomy including dimensions of veins for mapping purposes | |||
ASCI CT indication no. 44 |
Indication | Appropriateness criteria (median score) | Note | |
---|---|---|---|
Evaluation of myocardial scar
| |||
48 | To determine the location and extent of myocardial infarction including ‘no-reflow’ regions | A (9) | Highly agreed |
ACCF indication no. 30 | |||
Post-acute myocardial infarction | |||
49 | To detect post PCI myocardial necrosis | A (8) | Highly agreed |
ACCF indication no. 31 | |||
50 | To determine viability prior to revascularization | A (9) | Highly agreed |
ACCF indication no. 32 |
Indication | Appropriateness criteria (median score) | |
---|---|---|
Detection of CAD: symptomatic—evaluation of chest pain syndrome
| ||
3 | Intermediate pre-test probability of CAD | A (7) |
ECG uninterpretable OR unable to exercise | ||
Detection of CAD: symptomatic—evaluation of intra-cardiac structures
| ||
5 | Evaluation of suspected coronary anomalies | A (8) |
Detection of CAD with prior test results—evaluation of chest pain syndrome
| ||
16 | Uninterpretable or equivocal stress test (exercise, perfusion, or stress echo) | A (8) |
Risk Assessment with prior test results—asymptomatic
| ||
20 | Coronary angiography (catheterization or CT) | A (7) |
Stenosis of unclear significance | ||
CAD detection in pediatric patients with kawasaki disease—asymptomatic
| ||
22 | Previous tests (invasive angiography, CMR or CCT) documented coronary aneurysm/stenosis, for follow up | A (7) |
CAD detection in pediatric patients with kawasaki disease—symptomatic
| ||
23 | No previous definitive test (invasive angiography, MRCA or CTCA) available | A (7) |
24 | Previous tests (angiography, CMR or CCT) documented coronary aneurysm/stenosis, for follow up | A (7) |
Risk Assessment: preoperative evaluation for cardiac surgery or endovascular intervention—preoperative evaluation
| ||
28 | Anatomic assessment before percutaneous device closure of ASD or VSD or percutaneous aortic valve replacement | A (7) |
Structure and function—morphology
| ||
35 | Assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves | A (8) |
36 | Assessment of post-operative congenital heart disease, such as residual pulmonary stenosis, ventricular septal defect and patency check for Blalock-Taussig shunt | A (8) |
37 | Evaluation in patients with new onset heart failure to assess etiology | A (8) |
Structure and function—evaluation of ventricular and valvular function
| ||
39 | Evaluation of LV function following myocardial infarction OR in heart failure patients | A (9) |
Patients with technically limited images from echocardiogram | ||
38 | Evaluation of LV function following myocardial infarction OR in heart failure patients | A (8) |
40 | Quantification of LV function | A(9) |
Discordant information that is clinically significant from prior tests | ||
41 | Evaluation of specific cardiomyopathies (infiltrative [amyloid, sarcoid], HCM, or due to cardiotoxic therapies) | A(9) |
42 | Characterization of native and prosthetic cardiac valves | A (7) |
Patients with technically limited images from echocardiogram or TEE | ||
43 | Evaluation for arrhythmogenic right ventricular cardiomyopathy (ARVC) | A (8) |
Patients presenting with syncope or ventricular arrhythmia | ||
44 | Evaluation of myocarditis or myocardial infarction with normal coronary arteries | A(9) |
Positive cardiac enzymes without obstructive atherosclerosis on angiography | ||
Structure and function—evaluation of intra- and extra-cardiac structures
| ||
45 | Evaluation of cardiac mass (suspected tumor or thrombus) | A (9) |
Patients with technically limited images from echocardiogram or TEE | ||
46 | Evaluation of pericardial conditions (pericardial mass, constrictive pericarditis, or complications of cardiac surgery) | A (8) |
Patients with technically limited images from echocardiogram or TEE | ||
47 | Evaluation of pulmonary vein anatomy prior to invasive radiofrequency ablation for atrial fibrillation | A (7) |
Left atrial and pulmonary venous anatomy including dimensions of veins for mapping purposes | ||
Structure and function—evaluation of myocardial scar
| ||
48 | To determine the location and extent of myocardial infarction including ‘no-reflow’ regions | A (9) |
Post-acute myocardial infarction | ||
49 | To detect post PCI myocardial necrosis | A (8) |
50 | To determine viability prior to revascularization | A (9) |
Indication | Appropriateness criteria (median score) | |
---|---|---|
Detection of CAD: symptomatic—evaluation of chest pain syndrome
| ||
2 | Intermediate pre-test probability of CAD | U (4) |
ECG interpretable AND able to exercise | ||
4 | High pre-test probability of CAD | U (6) |
Detection of CAD: symptomatic—acute chest pain
| ||
6 | Low pre-test probability of CAD | U (4) |
No ECG changes and serial enzymes negative | ||
7 | Intermediate pre-test probability of CAD | U (5) |
No ECG changes and serial enzymes negative | ||
8 | High pre-test probability of CAD | U (5) |
No ECG changes and serial enzymes negative | ||
Detection of CAD: asymptomatic—asymptomatic
| ||
11 | Moderate CHD risk (Framingham) | U (4) |
12 | High CHD risk (Framingham) | U (6) |
Risk Assessment: general population—asymptomatic (use of coronary MRA)
| ||
15 | High CHD risk (Framingham) | U (5) |
Detection of CAD with prior test results—evaluation of chest pain syndrome
| ||
17 | Evidence of moderate to severe ischemia on stress test (exercise, perfusion, or stress echo) | U (5) |
Risk Assessment with prior test results—asymptomatic
| ||
19 | Equivocal stress test (exercise, stress SPECT, or stress echo) | U (6) |
Intermediate CHD risk (Framingham) | ||
CAD detection in pediatric patients with kawasaki disease—asymptomatic
| ||
21 | No previous definitive test (invasive angiography, MRCA or CTCA) available | U (5) |
Risk assessment: preoperative evaluation for non-cardiac surgery | ||
Intermediate- or high-risk surgery
| ||
26 | Intermediate perioperative risk | U (5) |
Risk assessment: preoperative evaluation for cardiac surgery or endovascular intervention—preoperative evaluation
| ||
27 | Use of MRI for CAD evaluation before valve surgery | U (6) |
29 | Evaluation of complex lesions before PCI (i.e., chronic total occlusions, bifurcation lesions) | U (5) |
Detection of CAD: post-revascularization (PCI or CABG)—evaluation of chest pain syndrome
| ||
30 | Evaluation of bypass grafts and coronary anatomy | U (5) |
31 | History of percutaneous revascularization with stents | U (4) |
Detection of CAD: post-revascularization (PCI or CABG)—asymptomatic
| ||
32 | Evaluation of bypass grafts and coronary anatomy | U (4) |
Less than 5 years after CABG | ||
33 | Evaluation of bypass grafts and coronary anatomy | U (4) |
Greater than or equal to 5 years after CABG |
Indication | Appropriateness criteria (median score) | |
---|---|---|
Detection of CAD: symptomatic—evaluation of chest pain syndrome
| ||
1 | Low pre-test probability of CAD | I (2) |
ECG interpretable AND able to exercise | ||
Detection of CAD: symptomatic—acute chest pain
| ||
9 | High pre-test probability of CAD | I (2) |
ECG—ST-segment elevation and/or positive cardiac enzymes | ||
Detection of CAD: asymptomatic (without chest pain syndrome)—asymptomatic
| ||
10 | Low CHD risk (Framingham risk criteria) | I (1) |
Risk assessment: general population—asymptomatic (use of coronary MRA)
| ||
13 | Low CHD risk (Framingham) | I (3) |
14 | Moderate CHD risk (Framingham) | I (3) |
Risk assessment with prior test results—asymptomatic
| ||
18 | Normal prior stress test (exercise, nuclear, echo, MRI) | I (3) |
High CHD risk (Framingham) | ||
Risk assessment: preoperative evaluation for non-cardiac surgery—low-risk surgery
| ||
25 | Intermediate perioperative risk | I (3) |
Detection of CAD: post-revascularization (PCI or CABG)—asymptomatic | ||
34 | Evaluation for in-stent restenosis and coronary anatomy after PCI | I (3) |