The role of cardiac magnetic resonance: European society of cardiology guidelines review

Laurynas Miščikas1, Martynas Bučnius1, Tomas Lapinskas2

1 Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

2 Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania


Introduction. Cardiac magnetic resonance (CMR) imaging is widely used in clinical practice worldwide. The ability to evaluate comprehensively the global and regional systolic ventricular function, characterize the structure of the myocardium, and identify pathologically altered tissues gives a unique value to this imaging modality. Although echocardiography due to its availability remains the most common investigative technique to identify heart disease, CMR is gaining more evidence, and has been included into recent guidelines for the diagnosis and treatment of different origin heart diseases. Our review aims to perform a systematic summary of the CMR representation in the guidelines of the European Society of Cardiology (ESC).

Methods. Starting from the year 2010, twenty-five ESC guidelines have been overviewed (listed on the ESC website: for the terms ”MRI“, ”CMR“, ”MR“, and ”magnetic“. The order of the guidelines starts from the most recent to the oldest. Not imaging-related guidelines were not included in our review. Furthermore, the class of recommendation and level of evidence were obtained (Table 1 and Table 2), as well as the main CMR-related conclusions.

Results. Fifteen of the 25 guidelines (60%) contained specific CMR using recommendations. Nine ESC guidelines (36%) mention and describe the potential benefits of CMR but do not provide the specific recommendation. One guideline (4%, ”2010 Focused update of ESC Guidelines on device therapy in heart failure“) do not mention CMR at all. The 15 guidelines with specific recommendations regarding the use of CMR contain following classes of recommendation: 31 class I, 13 class IIa, 15 class IIb, and 4 class III. Most of the recommendations have evidence level C (40/63; 63.5%), followed by level B (21/63; 33.3%) and level A (2/63; 3.2%).

Conclusions. CMR has become an important imaging tool with important value for the diagnosis and management of cardiovascular disease. While not all ESC guidelines include clear recommendations for CMR application, the usage of CMR is discussed in the large majority of the guidelines.


Keywords: Cardiac magnetic resonance; Magnetic resonance imaging; ESC Guidelines; Cardiology; Radiology.