Table 12

Stress Echocardiography Following Prior Test Results

IndicationAppropriate Use Score (1–9)
Asymptomatic: Prior Evidence of Subclinical Disease With Stress Echocardiography
136.
  • Coronary calcium Agatston score <100

I (2)
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)
139.
  • Coronary calcium Agatston score >400

A (7)
140.
  • Abnormal carotid intimal medial thickness (≥0.9 mm and/or the presence of plaque encroaching into the arterial lumen)

U (5)
Coronary Angiography (Invasive or Noninvasive) With Stress Echocardiography
141.
  • Coronary artery stenosis of unclear significance

A (8)
Asymptomatic or Stable Symptoms With Stress Echocardiography
Normal Prior Stress Imaging Study
142.
  • Low global CAD risk

  • Last stress imaging study <2 y ago

I (1)
143.
  • Low global CAD risk

  • Last stress imaging study ≥2 y ago

I (2)
144.
  • Intermediate to high global CAD risk

  • Last stress imaging study <2 y ago

I (2)
145.
  • Intermediate to high global CAD risk

  • Last stress imaging study ≥2 y ago

U (4)
Asymptomatic or Stable Symptoms With Stress Echocardiography
Abnormal Coronary Angiography or Abnormal Prior Stress Study
No Prior Revascularization
146.
  • Known CAD on coronary angiography or prior abnormal stress imaging study

  • Last stress imaging study <2 y ago

I (3)
147.
  • Known CAD on coronary angiography or prior abnormal stress imaging study

  • Last stress imaging study ≥2 y ago

U (5)
Treadmill ECG Stress Test With Stress Echocardiography
148.
  • Low-risk treadmill score (e.g., Duke)

I (1)
149.
  • Intermediate-risk treadmill score (e.g., Duke)

A (7)
150.
  • High-risk treadmill score (e.g., Duke)

A (7)
New or Worsening Symptoms With Stress Echocardiography
151.
  • Abnormal coronary angiography or abnormal prior stress imaging study

A (7)
152.
  • Normal coronary angiography or normal prior stress imaging study

U (6)
Prior Noninvasive Evaluation With Stress Echocardiography
153.
  • Equivocal, borderline, or discordant stress testing where obstructive CAD remains a concern

A (8)

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