Table 12

Uncertain Indications (Median Score 4 to 6)

IndicationAppropriateness Score (1–9)
Detection of CAD: Symptomatic—New-Onset/Diagnosed Heart Failure With Chest Pain Syndrome or Anginal Equivalent
10.
  • Intermediate pre-test probability

  • Abnormal LV systolic function

U (5)
Detection of CAD and Risk Assessment: Asymptomatic (Without Chest Pain Syndrome or Anginal Equivalent) General Patient Populations
13.
  • High CHD risk (Framingham)

U (6)
Detection of CAD/Risk Assessment: Without Chest Pain Syndrome or Anginal Equivalent in Patient Populations With Defined Comorbidities—New-Onset or Diagnosed Heart Failure or LV Systolic Dysfunction
15.
  • Moderate CHD risk (Framingham)

  • No prior CAD evaluation

  • Abnormal LV systolic dysfunction

U (5)
Risk Assessment With Prior Test Results—Asymptomatic OR Stable Symptoms, Normal Prior Stress Imaging Study
21.
  • High CHD risk

  • Repeat stress echo study after 2 years or greater

U (5)
Risk Assessment With Prior Test Results—Known CAD: Asymptomatic OR Stable Symptoms, Abnormal Catheterization OR Abnormal Prior Stress Imaging Study
23.
  • Assessment of severity of ischemia (CAD)

  • Greater than or equal to 2 years to evaluate medically managed patients

U (5)
Risk Assessment: Post-Revascularization (PCI or CABG)—Asymptomatic
37.
  • Asymptomatic (e.g., silent ischemia) prior to previous revascularization

  • Greater than or equal to 5 years after CABG

U (6)
38.
  • Symptomatic prior to previous revascularization

  • Greater than or equal to 5 years after CABG

U (5)
41.
  • Asymptomatic (e.g., silent ischemia) prior to previous revascularization

  • Greater than or equal to 2 years after PCI

U (5)
Stress Study for Hemodynamics (Includes Doppler During Stress)—Valvular Stenosis
44.
  • Asymptomatic individuals

  • Mild to moderate mitral stenosis

U (5)
Stress Study for Hemodynamics (Includes Doppler During Stress)—Pulmonary Hypertension
49.
  • Suspected pulmonary hypertension

  • Normal or indeterminate resting echo study

U (5)