Journal of the American College of Cardiology
Appropriate Use Criteria
ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart DiseaseA Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons
John U. Doherty, Smadar Kort, Roxana Mehran, Paul Schoenhagen, Prem Soman, Gregory J. Dehmer, John U. Doherty, Paul Schoenhagen, Thomas M. Bashore, Nicole M. Bhave, Dennis A. Calnon, Blase Carabello, John Conte, Timm Dickfeld, Daniel Edmundowicz, Victor A. Ferrari, Michael E. Hall, Brian Ghoshhajra, Praveen Mehrotra, Tasneem Z. Naqvi, T. Brett Reece, Randall C. Starling, Molly Szerlip, Wendy S. Tzou and John B. Wong
Table 4
Table 4
Sequential or Follow-Up Testing: Asymptomatic or Stable Symptoms
| Indication | TTE (With or Without 3D; With Contrast as Needed) | TEE (With or Without 3D) | Strain/Strain Rate Imaging by Speckle or Tissue Doppler | F-18 FDG-PET | Tc-99m PYP | CMR | CT | RVG |
|---|---|---|---|---|---|---|---|---|
| 55. Re-evaluation (<1 y) in a patient at risk for HF without structural heart disease on prior TTE and no change in clinical status or cardiac examination (stage A) | 2 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) |
| 56. Re-evaluation of known hypertensive heart disease without a change in clinical status or cardiac examination (stage A) (<1 y) | 2 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) |
| 57. Re-evaluation (<1 y) of HF (systolic or diastolic) cardiomyopathy or HF without a change in clinical status or cardiac examination | 2 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) |
| 58. Re-evaluation (<1 y) in a patient previously or currently undergoing therapy with potentially cardiotoxic agents | 7 (A) | 1 (R) | 7 (A) | 1 (R) | 1 (R) | 5 (M) | 2 (R) | 7 (A) |
| 59. Re-evaluation (<1 y) of known aortic dilatation at baseline study to assess changes in rate of expansion or size in patient without bicuspid aortic valve | 3 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 2 (R) | 3 (R) | 1 (R) |
| 60. Re-evaluation (<1 y) of the size and morphology of the aortic sinuses and ascending aorta in patients with a bicuspid aortic valve and an aortic diameter >4 cm without characteristics mentioned in #61 | 2 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 3 (R) | 3 (R) | 1 (R) |
61. Re-evaluation (<1 y) of the size and morphology of the aortic sinuses and ascending aorta in patients with a bicuspid aortic valve and an aortic diameter >4 cm with one of the following:
| 3 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 5 (M) | 5 (M) | 1 (R) |
| 62. Re-evaluation (<1 y) of known moderate or greater pulmonary hypertension without change in clinical status or cardiac examination | 4 (M) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) |
| 63. Re-evaluation (≥1 y) of known moderate or greater pulmonary hypertension without change in clinical status or cardiac examination | 7 (A) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 2 (R) | 1 (R) | 1 (R) |
| 64. Re-evaluation of chronic asymptomatic pericardial effusion when findings would potentially alter therapy | 7 (A) | 2 (R) | 1 (R) | 1 (R) | 1 (R) | 4 (M) | 3 (R) | 1 (R) |
| 65. Further clarification of suspected pericardial constriction when findings of TTE including tissue Doppler is unclear | 1 (R) | 3 (R) | 1 (R) | 1 (R) | 1 (R) | 7 (A) | 7 (A) | 1 (R) |
| 66. Re-evaluation of intracardiac mass when findings would potentially alter therapy | 8 (A) | 7 (A) | 1 (R) | 1 (R) | 1 (R) | 8 (A) | 8 (A) | 1 (R) |
| 67. Re-evaluation of prior TEE findings for interval change (e.g., resolution of atrial thrombus after anticoagulation) when no change in therapy is anticipated. | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) | 1 (R) |
3D = 3-dimensional; A = appropriate; CMR = cardiovascular magnetic resonance imaging; CT = computed tomography; F-18 FDG = fluorodeoxyglucose F18; HF = heart failure; M = may be appropriate; PET = positron emission tomography; R = rarely appropriate; RVG = radionuclide ventriculography; Tc-99m PYP = technetium-99m pyrophosphate; TEE = transesophageal echocardiography; TTE = transthoracic echocardiography.
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