Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines

Florian von Knobelsdorff-Brenkenhoff, Guenter Pilz, Jeanette Schulz-Menger, Florian von Knobelsdorff-Brenkenhoff, Guenter Pilz, Jeanette Schulz-Menger

Abstract

Background: Whereas evidence supporting the diagnostic value of cardiovascular magnetic resonance (CMR) has increased, there exists significant worldwide variability in the clinical utilization of CMR. A recent study demonstrated that CMR is represented in the majority of European Society for Cardiology (ESC) guidelines, with a large number of specific recommendations in particular regarding coronary artery disease. To further investigate the gap between the evidence and clinical use of CMR, this study analyzed the role of CMR in the guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA).

Methods: Twenty-four AHA/ACC original guidelines, updates and new editions, published between 2006 and 2017, were screened for the terms "magnetic", "MRI", "CMR", "MR" and "imaging". Non-cardiovascular MR examinations were excluded. All CMR-related paragraphs and specific recommendations for CMR including the level of evidence (A, B, C) and the class of recommendation (I, IIa, IIb, III) were extracted.

Results: Twelve of the 24 guidelines (50.0%) contain specific recommendations regarding CMR. Four guidelines (16.7%) mention CMR in the text only, and 8 (33.3%) do not mention CMR. The 12 guidelines with recommendations for CMR contain in total 65 specific recommendations (31 class-I, 23 class-IIa, 6 class-IIb, 5 class-III). Most recommendations have evidence level C (44/65; 67.7%), followed by level B (21/65; 32.3%). There are no level A recommendations. 22/65 recommendations refer to vascular imaging, 17 to congenital heart disease, 8 to cardiomyopathies, 8 to myocardial stress testing, 5 to left and right ventricular function, 3 to viability, and 2 to valvular heart disease.

Conclusions: CMR is represented in two thirds of the AHA/ACC guidelines, which contain a number of specific recommendations for the use of CMR. In a simplified comparison with the ESC guidelines, CMR is less represented in the AHA/ACC guidelines in particular in the field of coronary artery disease.

Keywords: Cardiac magnetic resonance; Cardiology; Guideline; Reimbursement.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

Jeanette Schulz-Menger is immediate past-president of the Society for Cardiovascular Magnetic Resonance. Florian von Knobelsdorff-Brenkenhoff is member of the executive committee of the working group CMR of the German Society for Cardiology.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Panel a Categorization of the 24 analyzed AHA/ACC guidelines regarding the role of CMR. Panel b Distribution of the 65 specific recommendations for CMR in the 24 AHA/ACC guidelines regarding “class of recommendations” and “level of evidence”. Panel c Categorization of the 65 specific recommendations in the 24 AHA/ACC guidelines regarding the diagnostic target

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