From: Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers
Modality | Indication | n (%) |
---|---|---|
TTE (n = 365) | ||
Appropriate | Initial evaluation of known or suspected HF (systolic or diastolic) based on symptoms, signs, or abnormal test results | 47 (13) |
Initial evaluation of ventricular function following ACS | 38 (10) | |
Initial evaluation of suspected infective endocarditis with positive blood cultures or a new murmur | 29 (8) | |
May be appropriate | 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 | 8 (2) |
Rarely appropriate | Lightheadedness/presyncope when there are no other symptoms or signs of cardiovascular disease | 4 (1) |
Infective endocarditis (native or prosthetic valves) with TTE: Transient bacteraemia with a pathogen not typically associated with infective endocarditis and/or a documented non endovascular source of infection | 3 (1) | |
Initial evaluation of ventricular function (e.g., screening) with no symptoms or signs of cardiovascular disease | 3 (1) | |
TEE (n = 29) | ||
Appropriate | To diagnose infective endocarditis with a moderate or high pre-test probability (e.g., staph. bacteremia, fungemia, prosthetic heart valve, or intra-cardiac device) | 8 (28) |
Atrial Fibrillation/Flutter: Evaluation to facilitate clinical decision making with regard to anticoagulation, cardioversion, and/or radiofrequency ablation Should add AUC 106? | 8 (28) | |
SPECT (n = 46) | ||
Appropriate | Risk assessment with prior test results and/or known chronic stable CAD: New or worsening symptoms & abnormal coronary angiography OR abnormal prior stress imaging study | 8 (17) |
Detection of CAD: acute chest pain; possible ACS with no ischemic changes or with LBBB or electronically ventricular paced rhythm, low-risk TIMI score & peak troponin borderline, equivocal or minimally elevated | 6 (13) | |
May be appropriate | New or worsening symptoms; Normal coronary angiography OR normal prior stress imaging study | 2 (4) |
Diagnostic Catheterization (n = 112) | ||
Appropriate | Suspected or known ACS: UA/NSTEMI | 64 (57) |
Valvular disease: Preoperative assessment before valvular surgery | 9 (14) | |
May be appropriate | Suspected CAD: Prior non-invasive testing (no prior PCI, CABG, or angiogram showing >50 % angiographic stenosis); ECG stress testing with intermediate-risk findings (e.g., Duke treadmill score 4 to 10) | 2 (2) |
Suspected CAD: Prior non-invasive testing (no prior PCI, CABG, or Angiogram Showing >50 % Angiographic Stenosis); Low-risk findings (e.g., 5 % ischemic myocardium on stress SPECT MPI or stress PET, no stress-induced wall motion abnormalities on stress echo or stress CMR) and symptomatic | 2 (2) |