14
Assessment
4.4. Evaluation With Cardiac Imaging
COR LOE
Recommendations
1 C-LD
1. In patients with suspected or new-onset HF, or those presenting
with acute decompensated HF, a chest x-ray should be
performed to assess heart size and pulmonary congestion and
to detect alternative cardiac, pulmonary, and other diseases that
may cause or contribute to the patient's symptoms.
1 C-LD
2. In patients with suspected or newly diagnosed HF, transthoracic
echocardiography (TTE) should be performed during initial
evaluation to assess cardiac structure and function.
1 C-LD
3. In patients with HF who have had a significant clinical change,
or who have received GDMT and are being considered for
invasive procedures or device therapy, repeat measurement of
EF, degree of structural remodeling, and valvular function are
useful to inform therapeutic interventions.
1 C-LD
4. In patients for whom echocardiography is inadequate,
alternative imaging (e.g., cardiac magnetic resonance [CMR],
cardiac computed tomography [CT], radionuclide imaging ) is
recommended for assessment of LVEF.
2a B-NR
5. In patients with HF or cardiomyopathy, CMR can be useful for
diagnosis or management.
2a B-NR
6. In patients with HF, an evaluation for possible ischemic
heart disease can be useful to identify the cause and guide
management.
2b B-NR
7. In patients with HF and CAD who are candidates for
coronary revascularization, noninvasive stress imaging (stress
echocardiography, single-photon emission CT [SPECT],
CMR, or positron emission tomography [PET]) may be
considered for detection of myocardial ischemia to help guide
coronary revascularization.
3: No
Benefit
C-EO
8. In patients with HF in the absence of: 1) clinical status change,
2) treatment interventions that might have had a significant
effect on cardiac function, or 3) candidacy for invasive
procedures or device therapy, routine repeat assessment of LV
function is not indicated.
