Table 6 Recommendations for CMR in valvular heart disease

Aortic regurgitation

 CMR is indicated in patients with moderate or severe AR (stages B, C, and D) and suboptimal echocardiographic images for the assessment of LV systolic function, systolic and diastolic volumes, and measurement of AR severity.

I

B

 Aortic magnetic resonance angiography or CT angiography is indicated in patients with a bicuspid aortic valve when morphology of the aortic sinuses, sinotubular junction, or ascending aorta cannot be assessed accurately or fully by echocardiography.

I

C

 Serial evaluation of the size and morphology of the aortic si- nuses and ascending aorta by echocardiography, CMR, or CT angiography is recommended in patients with a bicuspid aortic valve and an aortic diameter greater than 4.0 cm, with the examination interval determined by the degree and rate of progression of aortic dilation and by family history. In patients with an aortic diameter greater than 4.5 cm, this evaluation should be performed annually.

I

C

 CMR is indicated in patients with chronic primary MR to assess LV and RV volumes, function, or MR severity and when these issues are not satisfactorily addressed by TTE.

I

B

 Noninvasive imaging (stress nuclear/positron emission tomog- raphy, CMR, or stress echocardiography), cardiac CT angiography, or cardiac catheterization, including coronary arteriography, is useful to establish etiology of chronic secondary MR (stages B to D) and/or to assess myocardial viability, which in turn may influence management of functional MR.

I

C

 CMR or real-time 3D echocardiography may be considered for assessment of right ventricular systolic function and systolic and diastolic volumes in patients with severe tricuspid regurgitation (stages C and D) and suboptimal 2D echocardiograms.

IIb

C