Table 3

TTE for Evaluation of Valvular Function

IndicationAppropriate Use Score (1–9)
Murmur or Click With TTE
34.
  • Initial evaluation when there is a reasonable suspicion of valvular or structural heart disease

A (9)
35.
  • Initial evaluation when there are no other symptoms or signs of valvular or structural heart disease

I (2)
36.
  • Re-evaluation in a patient without valvular disease on prior echocardiogram and no change in clinical status or cardiac exam

I (1)
37.
  • Re-evaluation of known valvular heart disease with a change in clinical status or cardiac exam or to guide therapy

A (9)
Native Valvular Stenosis With TTE
38.
  • Routine surveillance (<3 y) of mild valvular stenosis without a change in clinical status or cardiac exam

I (3)
39.
  • Routine surveillance (≥3 y) of mild valvular stenosis without a change in clinical status or cardiac exam

A (7)
40.
  • Routine surveillance (<1 y) of moderate or severe valvular stenosis without a change in clinical status or cardiac exam

I (3)
41.
  • Routine surveillance (≥1 y) of moderate or severe valvular stenosis without a change in clinical status or cardiac exam

A (8)
Native Valvular Regurgitation With TTE
42.
  • Routine surveillance of trace valvular regurgitation

I (1)
43.
  • Routine surveillance (<3 y) of mild valvular regurgitation without a change in clinical status or cardiac exam

I (2)
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)
46.
  • Routine surveillance (≥1 y) of moderate or severe valvular regurgitation without change in clinical status or cardiac exam

A (8)
Prosthetic Valves With TTE
47.
  • Initial postoperative evaluation of prosthetic valve for establishment of baseline

A (9)
48.
  • Routine surveillance (<3 y after valve implantation) of prosthetic valve if no known or suspected valve dysfunction

I (3)
49.
  • Routine surveillance (≥3 y after valve implantation) of prosthetic valve if no known or suspected valve dysfunction

A (7)
50.
  • Evaluation of prosthetic valve with suspected dysfunction or a change in clinical status or cardiac exam

A (9)
51.
  • Re-evaluation of known prosthetic valve dysfunction when it would change management or guide therapy

A (9)
Infective Endocarditis (Native or Prosthetic Valves) With TTE
52.
  • Initial evaluation of suspected infective endocarditis with positive blood cultures or a new murmur

A (9)
53.
  • Transient fever without evidence of bacteremia or a new murmur

I (2)
54.
  • Transient bacteremia with a pathogen not typically associated with infective endocarditis and/or a documented nonendovascular source of infection

I (3)
55.
  • Re-evaluation of infective endocarditis at high risk for progression or complication or with a change in clinical status or cardiac exam

A (9)
56.
  • Routine surveillance of uncomplicated infective endocarditis when no change in management is contemplated

I (2)

A indicates appropriate; I, inappropriate; and U, uncertain.