Human In Vivo Cardiac Magnetic Resonance Imaging at 7 T: Feasibility, Applications, and Current Limitations—A Systematic Review

<b>Background/Objectives:</b> Cardiac magnetic resonance (CMR) imaging at 7 Tesla provides a substantially higher intrinsic signal-to-noise ratio compared with conventional 1.5 T and 3 T systems, potentially enabling higher spatial resolution, improved tissue contrast, and advanced metabolic imaging. However, clinical translation remains limited by technical challenges associated with ultra-high-field operation. This systematic review aimed to synthesize current human in vivo evidence on the feasibility, applications, and methodological limitations of 7-T cardiovascular MRI. <b>Methods:</b> A PRISMA-guided systematic search of PubMed, Cochrane Library, Web of Science, and Scopus was conducted from database inception through January 2025. Studies reporting human in vivo cardiovascular MRI at 7 Tesla were included. Data regarding study design, sample characteristics, imaging applications, feasibility, quantitative findings, and reported limitations were extracted and qualitatively synthesized. <b>Results:</b> Sixty-five studies met inclusion criteria, predominantly small prospective cohorts (mean sample size = 13), largely involving healthy volunteers. Across diverse applications-including coronary MR angiography, cine imaging, valvular assessment, vascular imaging, flow quantification, myocardial tissue characterization, and multinuclear (³¹P, ²³Na, ³⁹K) imaging-7-T CMR was consistently feasible and capable of producing high-quality images. Quantitative ventricular and vascular measurements were generally concordant with lower field strengths. Incremental benefits were most apparent in high-resolution structural imaging and metabolic applications, whereas routine functional and flow assessments showed limited additional advantages. No serious adverse events were reported. <b>Conclusions:</b> Human cardiovascular MRI at 7 Tesla represents a technically feasible research and early translational platform with selective advantages over established field strengths. Further advances in radiofrequency technology, protocol harmonization, and larger disease-focused studies are required to clarify its potential clinical role.