Society for Cardiovascular Magnetic Resonance

Five Things Physicians and Patients Should Question

Released January 16, 2014

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  1. 1

    Don’t perform stress cardiovascular magnetic resonance (CMR) in the initial evaluation of chest pain patients with low pretest probability of coronary artery disease.

    There are lower cost stress tests available for the initial evaluation of low-risk chest pain patients, particularly when they have a normal electrocardiogram and can exercise. Stress CMR can be valuable in evaluating intermediate-risk patients with abnormal electrocardiograms or who cannot exercise, or when initial test results are equivocal.

  2. 2

    Don’t perform stress CMR as a pre-operative assessment in patients scheduled to undergo low-risk, non-cardiac surgery.

    Stress testing has not been shown to be useful in patients undergoing low-risk surgery. Therefore, stress CMR in these patients will not improve outcomes and will increase cost.

  3. 3

    Don’t perform stress CMR in patients with acute chest pain and high probability of coronary artery disease.

    Stress testing can increase risk and delay therapy in patients with acute chest pain and markers of high risk, such as ST segment elevation and/or positive cardiac enzymes. After initial evaluation and therapy, non-stress CMR may aid in diagnosing ischemic or non-ischemic myocardial injury.

  4. 4

    Don’t perform coronary CMR in symptomatic patients with a history of coronary stents.

    Coronary stents cause artifacts on CMR that preclude accurate evaluation. Therefore, coronary CMR in these patients will not be diagnostic.

  5. 5

    Don’t perform coronary CMR in the initial evaluation of asymptomatic patients.

    Coronary CMR has not been well established for the evaluation of coronary atherosclerosis. Coronary CMR is primarily indicated for detecting and characterizing anomalous coronary arteries.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

Founded in 1994, the Society for Cardiovascular Magnetic Resonance (SCMR) is a professional association whose vision is to be the leading international representative and advocate for all physicians, scientists and technologists working in cardiovascular magnetic resonance imaging (CMR) to improve patient outcomes through excellence in education, training, standards, research and development. SCMR’s membership includes professionals from around the globe. Among the primary activities of SCMR are its annual scientific sessions and other courses, the open access online Journal of Cardiovascular Magnetic Resonance (www.jcmr-online.com) and the Society website (www.scmr.org).

How This List Was Created

The Society for Cardiovascular Magnetic Resonance (SCMR) has developed the following list of tests involving cardiovascular magnetic resonance imaging (CMR) thought to be overused or misused. This list was developed by a subcommittee of the SCMR and reviewed and approved by the SCMR Board of Trustees. The list was based primarily on appropriateness guidelines for CMR, published by both the American College of Cardiology and the American College of Radiology, with the goal of limiting the inappropriate use of expensive imaging testing in low-risk patients or where it is unlikely to add to clinical management.

SCMR’s disclosure and conflict of interest policy can be found at www.scmr.org.

Sources

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    American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Radiol. 2006 Oct;3(10):751–71.

    Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O’Reilly MG, Winters WL, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, Smith SC. ACC/AHA 2002 guideline update for exercise testing: summary article. J Am Coll Cardiol. 2002 Oct 16;40(8):1531–40.

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  2. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol. 2006 Oct 3;48(7):1475–97.

    American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Radiol. 2006 Oct;3(10):751–71.

    Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. J Am Coll Cardiol. 2007 Oct 23;50(17):1707–32.

  3. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol. 2006 Oct 3;48(7):1475–97.

    American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Radiol. 2006 Oct;3(10):751–71.

    Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. Circulation. 2011 May 10;123(18):e426–579.

  4. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol. 2006 Oct 3;48(7):1475–97.

    American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Radiol. 2006 Oct;3(10):751–71.

    Pennell DJ, Sechtem UP, Higgins CB, Manning WJ, Pohost GM, Rademakers FE, van Rossum AC, Shaw LJ, Yucel EK. Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report. J Cardiovasc Magn Reson. 2004;6(4):727–65.

  5. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol. 2006 Oct 3;48(7):1475–97.

    American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Radiol. 2006 Oct;3(10):751–71.

    Pennell DJ, Sechtem UP, Higgins CB, Manning WJ, Pohost GM, Rademakers FE, van Rossum AC, Shaw LJ, Yucel EK. Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report. J Cardiovasc Magn Reson.  2004;6(4):727–65.