Methods We retrospectively reviewed charts of 361 patients who underwent CMR exams (GE 1.5 T, Milwaukee, WI) over a six-month period at two centers. Center 1 was an academic-community hospital in Western Pennsylvania, also offering specialty services for pulmonary hypertension and cardiac transplantation. Center 2 was a private community hospital in Western Pennsylvania. Studies were reviewed for compliance with the Appropriateness Criteria for CMR published by the American College of Cardiology (ACC) in 2006. All components of CMR exam such as structure and function, phase velocity mapping (PVM), MR angiography (MRA), delayed hyperenhancement (DHE) and stress perfusion (SP) were recorded. Patient outcomes were assessed to see if CMR resulted in any independent new information, or it merely confirmed another modality. "Significant contribution", as assessed by a cardiac MRI expert at each center was defined as either: 1) new treatment 2) change in current treatment 3) important information that was missed by other imaging modalities. Disparities in assessment were settled by consensus between the two experts.