Table 12 Recommendations for CMR in the guidelines for the diagnosis and management of chronic coronary syndromes

CMR in the initial diagnostic management of patients with suspected coronary artery disease (CAD)

CMR may be considered in patients with an inconclusive echocardiographic test

IIb

C

Use of diagnostic imaging tests in the initial diagnostic management of symptomatic patients with suspected CAD

Non-invasive functional imaging for myocardial ischemia or coronary CTA is recommended as the initial test for diagnosing CAD in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone

I

B

It is recommended that selection of the initial non-invasive diagnostic test is done based on the clinical likelihood of CAD and other patient characteristics that influence test performance, local expertise, and the availability of tests

I

C

Functional imaging for myocardial ischemia is recommended if coronary CTA has shown CAD of uncertain functional significance or is not diagnostic

I

B

Recommendations on risk assessment

Risk stratification, preferably using stress imaging or coronary CTA (if local expertise and availability permit), or alternatively exercise stress ECG (if significant exercise can be performed and the ECG is amenable to the identification of ischemic changes), is recommended in patients with suspected or newly diagnosed CAD

I

B

Recommendations for screening for coronary artery disease in asymptomatic subjects

In high-risk asymptomatic adults (with diabetes, a strong family history of CAD, or when previous risk-assessment tests suggest a high risk of CAD), functional imaging or coronary CTA may be considered for cardiovascular risk assessment

IIb

C

In low-risk non-diabetic asymptomatic adults, coronary CTA or functional imaging for ischemia is not indicated for further diagnostic assessment

III

C

In asymptomatic adults (age > 40 years) with diabetes, functional imaging or coronary CTA may be considered for advanced cardiovascular risk assessment

IIb

B

Recommendations for symptomatic patients with a long-standing diagnosis of chronic coronary syndromes

Risk stratification is recommended in patients with new or worsening symptom levels, preferably using stress imaging or, alternatively, exercise stress ECG

I

B

Investigations in patients with suspected coronary microvascular angina

Transthoracic Doppler of the LAD, CMR, and PET may be considered for non-invasive assessment of coronary flow reserve (CFR)

IIb

B