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Table 3 Most common indications per imaging modality

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)

  1. Table listing the most commonly recorded indications in each appropriateness category for each imaging modality. TTE transthoracic echocardiography, TEE transesophageal echocardiography, SPECT single-photon emission tomography myocardial perfusion imaging