ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure.

Published

Journal Article

While there is no single diagnostic test for heart failure (HF), imaging plays a supportive role beginning with confirmation of HF, especially by detecting ventricular dysfunction (Variant 1). Ejection fraction (EF) is important in HF classification, and imaging plays a subsequent role in differentiation between HF with reduced EF (HFrEF) versus preserved EF (HFpEF) (Variant 2). Once HFrEF is identified, distinction between ischemic and nonischemic etiologies with imaging support (Variant 3) facilitates further planning. Imaging approaches which are usually appropriate include: both resting transthoracic echocardiography (TTE) and chest radiography for Variant 1; resting TTE and/or MRI (including functional, without absolute need for contrast) for Variant 2; and for Variant 3, a. Coronary CTA or coronary arteriography (if high pretest probability/symptoms for ischemic disease) for coronary assessment; b. Rest/vasodilator stress SPECT/CT, PET/CT, or MRI for myocardial perfusion assessment; c. Rest/exercise or inotropic stress TTE for myocardial contraction assessment; or d. MRI (including morphologic with contrast) for myocardial characterization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Full Text

Duke Authors

Cited Authors

  • Expert Panel on Cardiac Imaging:, ; White, RD; Kirsch, J; Bolen, MA; Batlle, JC; Brown, RKJ; Eberhardt, RT; Hurwitz, LM; Inacio, JR; Jin, JO; Krishnamurthy, R; Leipsic, JA; Rajiah, P; Shah, AB; Singh, SP; Villines, TC; Zimmerman, SL; Abbara, S

Published Date

  • November 2018

Published In

Volume / Issue

  • 15 / 11S

Start / End Page

  • S418 - S431

PubMed ID

  • 30392610

Pubmed Central ID

  • 30392610

Electronic International Standard Serial Number (EISSN)

  • 1558-349X

Digital Object Identifier (DOI)

  • 10.1016/j.jacr.2018.09.031

Language

  • eng

Conference Location

  • United States