We analyze two 3D general-relativistic magnetohydrodynamic accretion simulations in the context of how they would manifest in Event Horizon Telescope (EHT) observations of supermassive black holes. The two simulations differ only in whether the initial angular momentum of the plasma is aligned with the rapid (a = 0.9) spin of the black hole. Both have low net magnetic flux. Ray tracing is employed to generate resolved images of the synchrotron emission. When using parameters appropriate for Sgr A* and assuming a viewing angle aligned with the black hole spin, we find the most prominent difference is that the central shadow in the image is noticeably eccentric in tilted models, with the ring of emission relatively unchanged. Applying this procedure to M87 with a viewing angle based on the large-scale jet, we find that adding tilt increases the angular size of the ring for fixed black hole mass and distance, while at the same time increasing the number of bright spots in the image. Our findings illustrate observable features that can distinguish tilted from aligned flows. They also show that tilted models can be viable for M87, and that not accounting for tilt can bias inferences of physical parameters. Future modeling of horizon-scale observations should account for potential angular momentum misalignment, which is likely generic at the low accretion rates appropriate for EHT targets.