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Follow-up
Clinical Evaluation, Echocardiography During Routine,
Periodic Follow-Up
Î Patients with SIHD should receive periodic follow-up, at least annually,
that includes all of the following: (I-C)
• Assessment of symptoms and clinical function
• Surveillance for complications of SIHD, including heart failure and arrhythmias
• Monitoring of cardiac risk factors
• Assessment of the adequacy of and adherence to recommended lifestyle changes
and medical therapy
ÎAssessment of LVEF and segmental wall motion by echocardiography or
radionuclide imaging is recommended in patients with new or worsening
heart failure or evidence of intervening MI by history or ECG. (I-C)
Î Periodic screening for important comorbidities that are prevalent in
patients with SIHD, including diabetes mellitus, depression, and CKD,
might be reasonable. (IIb-C)
Î A resting 12-lead ECG at 1-year or longer intervals between studies in
patients with stable symptoms might be reasonable. (IIb-C)
Î Measurement of LV function with a technology such as
echocardiography or radionuclide imaging is NOT recommended for
routine periodic reassessment of patients who have not had a change
in clinical status or who are at low risk of adverse cardiovascular
events. (III-C: No Benefit)
Noninvasive Testing in Known SIHD
Follow-Up Noninvasive Testing in Patients With Known SIHD:
New, Recurrent, or Worsening Symptoms Not Consistent With
Unstable Angina
Patients Able to Exercise
Î Standard exercise ECG testing is recommended in patients with known
SIHD who have new or worsening symptoms not consistent with UA
and who have: (I-B)
• at least moderate physical functioning and no disabling comorbidity and
• an interpretable ECG
Î Exercise with nuclear MPI or echocardiography is recommended in
patients with known SIHD who have new or worsening symptoms not
consistent with UA and who have: (I-B)
• at least moderate physical functioning or no disabling comorbidity but
• an uninterpretable ECG
