Table 3

Diagnostic and Therapeutic Procedures Elements

Data FieldDefinitionValue DomainNotesSource
Diagnostic Procedures
Cardiac diagnostic procedureProcedure to evaluate the structure and/or function of the heart. This lexicon emphasizes common names for procedure concepts even when various subprocedures make up the concept (e.g., transthoracic echocardiogram, left-heart catheterization), rather than an unbundled listing of the subprocedures that make up the procedure (e.g., CPT code listing). The procedure of greater complexity should be chosen when the concept of greater complexity is inclusive of the one of lesser complexity (e.g., stress echocardiography is inclusive of TTE). Selected results data (listed in the next section below) are to be linked to the study.
  • • ECG

  • • Holter monitor

  • • Event monitor

  • • Electrophysiology study

  • • Transthoracic echocardiography

  • • Transesophageal echocardiography

  • • Stress ECG

  • • Stress echocardiography

  • • Nuclear stress test

  • • MRI

  • • Stress MRI

  • • Cardiac MR angiography

  • • Cardiac CT angiography

  • • CT (noncontrast)

  • • PET

  • • Right-heart catheterization

  • • Biopsy of the right ventricle

  • • Left-heart catheterization

  • ECG

  • Holter monitor

  • Event monitor

  • EPS

  • TTE

  • TEE

  • Stress ECG

  • Stress echo

  • Nuclear stress test

  • MRI

  • Stress MRI

  • Cardiac MR angiography

  • Cardiac CT angiography

  • Computerized tomography (noncontrast)

  • CTA

  • PET

  • RHC

  • RVBx

  • LHC

Values are mutually exclusive from one diagnostic area to the next but not within one diagnostic modality.ACCF/AHA Cardiac Imaging Data Standards (18)
Date of cardiac diagnostic procedureDate of cardiac diagnostic procedureDateRequires month/year; day if availableACCF/AHA Cardiac Imaging Data Standards (18)
Diagnostic Procedure ResultsNotes: This is purposely only a partial listing of all possible results, focusing on the key results with critical diagnostic, therapeutic, or prognostic significance. When reported, the result is linked to the diagnostic test.
Ejection fraction (quantitative)The calculated resting LVEF as either a percentage value or the midpoint value when a range is reportedNumberACCF/AHA Cardiac Imaging Data Standards (18)
Ejection fraction (qualitative)
  • The estimated resting LVEF as a qualitative score:

  • • Hyperdynamic: >70%

  • • Normal: 50%–70% (midpoint 60%)

  • • Mild dysfunction: 40%–49% (midpoint 45%)

  • • Moderate dysfunction: 30%–39% (midpoint 35%)

  • • Severe dysfunction: <30% (midpoint 20%)

  • Hyperdynamic

  • Normal

  • Mild dysfunction

  • Moderate dysfunction

  • Severe dysfunction

ACCF/AHA Cardiac Imaging Data Standards (18)
Left ventricle size, end diastole (quantitative)Short-axis measurement of the left ventricular chamber size at end diastole, in centimetersNumber (cm)
Left ventricle size, end systole (quantitative)Short-axis measurement of the left ventricular chamber size at end systole, in centimetersNumber (cm)
Left atrium size (quantitative)Size of the left atrium, in centimetersNumber (cm)
Aortic valve areaSeverity of stenosis of the aortic valve, in square centimetersNumber (cm2)ACCF/AHA Cardiac Imaging Data Standards (18)
Aortic valve regurgitationSeverity of regurgitation through the aortic valve:
  • • None

  • • Mild

  • • Moderate

  • • Severe

  • None

  • Mild

  • Moderate

  • Severe

ACCF/AHA Cardiac Imaging Data Standards (18)
Mitral valve areaSeverity of stenosis of the mitral valve, in square centimetersNumber (cm2)ACCF/AHA Cardiac Imaging Data Standards (18)
Mitral valve regurgitationSeverity of regurgitation through the mitral valve:
  • • None

  • • Mild

  • • Moderate

  • • Severe

  • None

  • Mild

  • Moderate

  • Severe

ACCF/AHA Cardiac Imaging Data Standards (18)
Stress test resultResult of functional cardiac testing evaluating for evidence of myocardial ischemia
  • Normal

  • Abnormal

  • Indeterminate

ACCF/AHA Cardiac Imaging Data Standards (18)
Myocardium ischemic amount (qualitative)Qualitative amount of myocardium estimated to be ischemic per functional study (e.g., echocardiogram, MRI, SPECT)
  • None

  • Small

  • Medium

  • Large

Coronary calcium scoreAgatston score of estimate of extent of coronary calcification by coronary CTNumberACCF/AHA Cardiac Imaging Data Standards (18)
Coronary artery number of diseased vessels (excludes left main disease)Number of major epicardial vessels and major branches of epicardial vessels with ≥70% luminal obstruction:
  • • None

  • • 1

  • • 2

  • • 3

  • 0

  • 1

  • 2

  • 3

Left main coronary artery stenosisLeft main coronary disease is present when there is ≥50% compromise of vessel diameter.
  • Yes

  • No

  • [null]

STS Registry v2.70 (15)
Proximal LAD coronary artery stenosisLuminal narrowing of the proximal LAD at the point of maximal stenosis is ≥70%.
  • Yes

  • No

  • [null]

Third-degree AV block (complete heart block)Heart rhythm characterized by independent atrial and ventricular complexes with atrial rate usually exceeding ventricular rate
  • Yes

  • No

  • [null]

ACCF/AHA Electrophysiology Data Standards (16)
Left bundle-branch blockECG pattern of LBBB characterized by QRS duration of ≥120 ms, delayed onset of intrinsicoid deflection in leads 1, V5, and V6 ≥60 ms; broad and notched or slurred R waves in I, aVL, V5, and V6; RS or QS complexes in right precordial leads; ST segment and T waves in opposite polarity to the major QRS deflection
  • Yes

  • No

  • [null]

ACCF/AHA Electrophysiology Data Standards (16)
Intraventricular conduction delay (nonspecific)ECG pattern of intraventricular conduction delay characterized by QRS duration ≥110 ms that does not meet morphology criteria of LBBB or RBBB
  • Yes

  • No

  • [null]

ACCF/AHA Electrophysiology Data Standards (16)
Therapeutic Procedures
Cardiac therapeutic procedureProcedure to treat pathologic structural/pathophysiological functional disorder of the heart. This lexicon emphasizes common names for procedure concepts even when various subprocedures make up the concept (e.g., CRT, PCI) rather than an unbundled listing of the subprocedures that make up the procedure (e.g., CPT code listing). The procedure of greatest complexity should be chosen when the concept of greater complexity is inclusive of the one of lesser complexity (e.g., ICD is inclusive of pacemaker). Selected results data (listed in the next section below) are to be linked to the study:
  • • Ablation, atrial (e.g., for AF)

  • • Ablation, ventricular (e.g., for VT)

  • • Ablation, other (e.g., reciprocating tachycardia ablation)

  • • Pacemaker

  • • ICD

  • • CRT

  • • Lead extraction

  • • Electrical cardioversion

  • • Chemical cardioversion

  • • PCI

  • • Septal ablation

  • • Transcatheter aortic valve implant

  • • Closure device, atrial

  • • Closure device, ventricular

  • • CABG

  • • Aortic balloon valvotomy

  • • Aortic valve replacement

  • • Mitral valve repair

  • • Mitral valve replacement

  • • Mitral balloon valvotomy

  • • Mitral commissurotomy

  • • Percutaneous mitral repair

  • • Tricuspid valve repair

  • • Tricuspid valve replacement

  • • Pulmonic valvuloplasty

  • • Pulmonary valve replacement

  • • Surgical maze

  • • Pericardiocentesis

  • • Pericardial window

  • • Pericardial stripping

  • • Left atrial appendage occlusion

  • • Ventricular aneurysm resection

  • • Left VAD

  • • Right VAD

  • • Heart transplant

  • Ablation, atrial

  • Ablation, ventricular

  • Ablation, other

  • Pacemaker

  • ICD

  • CRT

  • Lead extraction

  • Electrical cardioversion

  • Chemical cardioversion

  • PCI

  • Septal ablation

  • Transcatheter aortic valve implant

  • Closure device, atrial

  • Closure device, ventricular

  • CABG

  • Aortic balloon valvotomy

  • Aortic valve replacement

  • Mitral valve repair

  • Mitral valve replacement

  • Mitral balloon valvotomy

  • Mitral commissurotomy

  • Percutaneous mitral repair

  • Tricuspid valve repair

  • Tricuspid valvuloplasty

  • Pulmonary valvuloplasty

  • Pulmonary valve replacement

  • Surgical maze

  • Pericardiocentesis

  • Pericardial window

  • Pericardial stripping

  • Left atrial appendage occlusion

  • Aneurysmectomy

  • VAD, left

  • VAD, right

  • Heart transplant

Values are mutually exclusive from one therapeutic area to the next but not within one therapeutic modality.
Date of therapeutic procedureDate of cardiac therapeutic procedureDate (requires month/year; day if available)
Therapeutic Procedure Device Implants
Implanted device
  • Type of device implanted

  • • Single-chamber pacemaker

  • • Dual-chamber pacemaker

  • • Biventricular pacemaker

  • • Cardioverter-defibrillator

  • • Cardioverter-defibrillator with resynchronization

  • • Atrial lead, right

  • • Atrial lead, left

  • • Ventricular lead, right

  • • Ventricular lead, left

  • • Bare-metal stent

  • • Drug-eluting stent

  • • Closure device, atrial

  • • Closure device, ventricular

  • • Aortic valve, mechanical

  • • Aortic valve, tissue

  • • Aortic valve, transcutaneous

  • • Mitral valve, mechanical

  • • Mitral valve, tissue

  • • Left VAD

  • • Right VAD

  • • Total artificial heart

  • Single-chamber pacemaker

  • Dual-chamber pacemaker

  • Biventricular pacemaker

  • Cardioverter-defibrillator

  • Cardioverter-defibrillator–resynchronization

  • Atrial lead, right

  • Atrial lead, left

  • Ventricular lead, right

  • Ventricular lead, left

  • Bare-metal stent

  • Drug-eluting stent

  • Closure device, atrial

  • Closure device, ventricular

  • Aortic valve, mechanical

  • Aortic valve, tissue

  • Aortic valve, transcutaneous

  • Mitral valve, mechanical

  • Mitral valve, tissue

  • VAD, left

  • VAD, right

  • Total artificial heart

Each implanted device is to be associated with a manufacturer, model, serial number, and device parameters as appropriate for the device.
ManufacturerManufacturer of the implanted deviceText
ModelModel of the implanted deviceText
Serial numberSerial number of the implanted device, if applicableText
Device parametersKey manufacturer's specification of the implanted device (e.g., size of stent)Text
Coronary lesions treatedPer the CASS coronary artery segment map, lesion(s) treated during a PCI procedure.Text
Coronary graft anastomosesPer the CASS coronary artery segment map, anastomoses placed during a CABG procedure.Text

ACCF indicates American College of Cardiology; AF, atrial fibrillation; AHA, American Heart Association; AV block, atrioventricular block; CABG, coronary artery bypass graft; CASS, Coronary Artery Surgery Study; CPT, Code of Procedural Terminologies; CRT, cardiac resynchronization therapy; CT, computed tomography; CTA, computed tomography angiography; ECG, electrocardiogram; EPS, electrophysiological study; ICD, implantable cardioverter-defibrillator; LAD, left anterior descending; LBBB, left bundle-branch block; LHC, left-heart catheterization; LVEF, left ventricular ejection fraction; MR, magnetic resonance; MRI, magnetic resonance imaging; PCI, percutaneous coronary intervention; PET, positron emission tomography; PQRI, Physician Quality Reporting Initiative; RBBB, right bundle-branch block; RHC, right-heart catheterization; RVBx, right ventricular endomyocardial biopsy; SPECT, single-photon emission computed tomography; STS, Society of Thoracic Surgeons; TEE, transesophageal echocardiogram; TTE, transthoracic echocardiogram; VAD, ventricular assist device; and VT, ventricular tachycardia.

  • The data element/definition is a 2010 PQRI Measures data point (25a).