Table 12 Recommendations for CMR in stable coronary artery disease

Recommendations for non-invasive testing for ischemic heart disease

Class^a

Level^b

Page

 In patients with suspected stable coronary artery disease and intermediate pretest probability of 15 % - 65 % and LVEF ≥50 %, stress imaging is preferred as the initial test option if local expertise and availability permit.

I

B

17

 An imaging stress test is recommended as the initial test for diagnosing stable coronary artery disease if the pretest probability is between 66-85 % or if LVEF is <50 % in patients without typical angina.

I

B

17

 An imaging stress test is recommended in patients with resting ECG abnormalities, which prevent accurate interpretation of ECG changes during stress.

I

B

17

 An imaging stress test should be considered in symptomatic patients with prior revascularization (PCI or CABG).

IIa

B

17

 An imaging stress test should be considered to assess the functional severity of intermediate lesions on coronary arteriography.

IIa

B

17

Recommendations for risk stratification using ischemia testing

Class^a

Level^b

Page

 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

I

B

22

 Stress imaging for risk stratification is recommended in patients with a non-conclusive exercise ECG

I

B

22

 Risk stratification using stress ECG (unless they cannot exercise or display ECG changes which make the ECG non evaluable) or preferably stress imaging if local expertise and availability permit is recommended in patients with stable coronary disease after a significant change in symptom level

I

B

22

 Stress imaging 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

I

B

22

 In asymptomatic adults with diabetes or asymptomatic adults with a strong family history of coronary artery disease or when previous risk assessment testing suggests high risk of coronary artery disease, such as a coronary artery calcium score of 400 or greater stress imaging tests (MPI, stress echocardiography, perfusion CMR) may be considered for advanced cardiovascular risk assessment.

IIb

C

24

Recommendation for re-assessment in patients with stable coronary artery disease

Class^a

Level^b

Page

 An exercise ECG or stress imaging if appropriate is recommended in the presence of recurrent or new symptoms once instability has been ruled out.

I

C

25

 Reassessment of the prognosis using stress testing may be considered in asymptomatic patients after the expiration of the period for which the previous test was felt to be valid (“warranty period”)

IIb

C

25

 In symptomatic patients with revascularized stable coronary artery disease, stress imaging (stress echocardiography, CMR or MPS) is indicated rather than stress ECG.

I

C

47

 Late (6 months) stress imaging test after revascularization may be considered to detect patients with restenosis after stenting or graft occlusion irrespective of symptoms.

IIb

C

47