Table 20

Uncertain Indications (Median Score 4–6)

IndicationAppropriate Use Score (1–9)
TTE for General Evaluation of Cardiac Structure and Function Perioperative Evaluation
14.
  • Routine perioperative evaluation of cardiac structure and function prior to noncardiac solid organ transplantation

U (6)
TTE for Cardiovascular Evaluation in an Acute Setting
Hypotension or Hemodynamic Instability
20.
  • Assessment of volume status in a critically ill patient

U (5)
TTE for Cardiovascular Evaluation in an Acute Setting
Respiratory Failure
27.
  • Respiratory failure or hypoxemia when a noncardiac etiology of respiratory failure has been established

U (5)
TTE for Evaluation of Valvular Function
Native Valvular Regurgitation
44.
  • Routine surveillance (≥3 y) of mild valvular regurgitation without a change in clinical status or cardiac exam

U (4)
45.
  • Routine surveillance (<1 y) of moderate or severe valvular regurgitation without a change in clinical status or cardiac exam

U (6)
TTE for Evaluation of Hypertension, HF, or Cardiomyopathy Hypertension
69.
  • Re-evaluation of known hypertensive heart disease without a change in clinical status or cardiac exam

U (4)
TTE for Evaluation of Hypertension, HF, or Cardiomyopathy HF
72.
  • Re-evaluation of known HF (systolic or diastolic) with a change in clinical status or cardiac exam with a clear precipitating change in medication or diet

U (4)
75.
  • Routine surveillance (≥1 y) of HF (systolic or diastolic) when there is no change in clinical status or cardiac exam

U (6)
TTE for Evaluation of Hypertension, HF, or Cardiomyopathy Device Evaluation (Including Pacemaker, ICD, or CRT)
77.
  • Initial evaluation for CRT device optimization after implantation

U (6)
TTE for Evaluation of Hypertension, HF, or Cardiomyopathy Cardiomyopathies
89.
  • Routine surveillance (≥1 y) of known cardiomyopathy without a change in clinical status or cardiac exam

U (5)
TTE for Adult Congenital Heart Disease
96.
  • Routine surveillance (≥2 y) of adult congenital heart disease following complete repair

    • without residual structural or hemodynamic abnormality

    • without a change in clinical status or cardiac exam

U (6)
97.
  • Routine surveillance (<1 y) of adult congenital heart disease following incomplete or palliative repair

    • with residual structural or hemodynamic abnormality

    • without a change in clinical status or cardiac exam

U (5)
TEE as Initial or Supplemental Test—Embolic Event
110.
  • Evaluation for cardiovascular source of embolus with a previously identified noncardiac source

U (5)
Stress Echocardiography for Detection of CAD/Risk Assessment: Asymptomatic (Without Ischemic Equivalent) General Patient Populations
126.
  • Intermediate global CAD risk

  • ECG uninterpretable

U (5)
127.
  • High global CAD risk

U (5)
Stress Echocardiography for Detection of CAD/Risk Assessment: Asymptomatic (Without Ischemic Equivalent) in Patient Populations With Defined Comorbidities Arrhythmias
132.
  • New-onset atrial fibrillation

U (6)
Stress Echocardiography Following Prior Test Results Asymptomatic: Prior Evidence of Subclinical Disease
137.
  • Low to intermediate global CAD risk

  • Coronary calcium Agatston score between 100 and 400

U (5)
138.
  • High global CAD risk

  • Coronary calcium Agatston score between 100 and 400

U (6)
140.
  • Abnormal carotid intimal medial thickness (≥0.9 mm and/or the presence of plaque encroaching into the arterial lumen)

U (5)
Stress Echocardiography Following Prior Test Results Asymptomatic or Stable Symptoms Normal Prior Stress Imaging Study
145.
  • Intermediate to high global CAD risk

  • Last stress imaging study ≥2 y ago

U (4)
Stress Echocardiography Following Prior Test Results
Asymptomatic or Stable Symptoms Abnormal Coronary Angiography or Abnormal Prior Stress Study No Prior Revascularization
147.
  • Known CAD on coronary angiography or prior abnormal stress imaging study

  • Last stress imaging study ≥2 y ago

U (5)
Stress Echocardiography Following Prior Test Results New or Worsening Symptoms
152.
  • Normal coronary angiography or normal prior stress imaging study

U (6)
Stress Echocardiography for Risk Assessment: Perioperative Evaluation for Noncardiac Surgery Without Active Cardiac Conditions Intermediate-Risk Surgery
157.
  • ≥1 clinical risk factor

  • Poor or unknown functional capacity (<4 METs)

U (6)
Stress Echocardiography for Risk Assessment: Postrevascularization (PCI or CABG) Asymptomatic
172.
  • ≥5 y after CABG

U (6)
174.
  • ≥2 y after PCI

U (5)
Stress Echocardiography for Hemodynamics (Includes Doppler During Stress) Chronic Valvular Disease—Asymptomatic
178.
  • Moderate mitral stenosis

U (5)
181.
  • Moderate aortic stenosis

U (6)
182.
  • Severe aortic stenosis

U (5)
184.
  • Moderate mitral regurgitation

U (5)
187.
  • Moderate aortic regurgitation

U (5)
Stress Echocardiography for Hemodynamics (Includes Doppler During Stress) Chronic Valvular Disease—Symptomatic
189.
  • Mild mitral stenosis

U (5)
194.
  • Mild mitral regurgitation

U (4)
Stress Echocardiography for Hemodynamics (Includes Doppler During Stress) Pulmonary Hypertension
198.
  • Suspected pulmonary hypertension

  • Normal or borderline elevated estimated right ventricular systolic pressure on resting echocardiographic study

U (5)
200.
  • Re-evaluation of patient with exercise-induced pulmonary hypertension to evaluate response to therapy

U (5)

U indicates uncertain.