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Table 10 Recommendations for CMR for risk stratification and follow-up in stable coronary artery disease

From: Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines

  Classa Levelb Page
Resting imaging to assess cardiac structure and function    
 Echocardiography, radionuclide imaging, CMR, and cardiac CT are not recommended for routine assessment of LV function in patients with a normal ECG, no history of myocardial infarction, no symptoms or signs suggestive of heart failure, and no complex ventricular arrhythmias. III C 29
 Routine reassessment (<1 year) of LV function with technologies such as echocardiography, radionuclide imaging, CMR, or cardiac CT is not recommended in patients with no change in clinical status and for whom no change in therapy is contemplated. III C 31
Risk assessment in patients able to exercise
 CMR with pharmacological stress is reasonable for risk assessment in patients with stable ischemic heart disease who are able to exercise to an adequate workload but have an uninterpretable ECG. IIa B 30
 Pharmacological stress imaging (nuclear MPI, echocardiography, or CMR) or CCTA is not recommended for risk assessment in patients with stable ischemic heart disease who are able to exercise to an adequate workload and have an interpretable ECG. III C 30
Risk assessment in patients unable to exercise
 Pharmacological stress CMR is reasonable for risk assessment in patients with stable ischemic heart disease who are unable to exercise to an adequate workload regardless of interpretability of ECG. IIa B 30
Risk assessment regardless of patients’ ability to exercise
 Either exercise or pharmacological stress with imaging (nuclear MPI, echocardiography, or CMR) is recommended for risk assessment in patients with stable ischemic heart disease, who are being considered for revascularization of known coronary stenosis of unclear physiological significance. I B 31
  1. aClass of recommendation
  2. bLevel of evidence