16
Diagnosis
Resting Imaging to Assess Cardiac Structure and Function
Î Assessment of resting left ventricular (LV) systolic and diastolic
function and evaluation for abnormalities of myocardium, heart
valves, or pericardium are recommended with the use of Doppler
echocardiography in patients with known or suspected IHD and a prior
myocardial infarction (MI), pathological Q waves, symptoms or signs
suggestive of heart failure, complex ventricular arrhythmias, or an
undiagnosed heart murmur. (I-B)
Î Assessment of cardiac structure and function with resting
echocardiography may be considered in patients with hypertension or
diabetes mellitus and an abnormal ECG. (IIb-C)
Î Measurement of LV function with radionuclide imaging may be
considered in patients with a prior MI or pathological Q waves,
provided there is no need to evaluate symptoms or signs suggestive
of heart failure, complex ventricular arrhythmias, or an undiagnosed
heart murmur. (IIb-C)
Î Echocardiography, radionuclide imaging, CMR, and cardiac CT are NOT
recommended for routine assessment of LV function in patients with a
normal ECG, no history of MI, no symptoms or signs suggestive of heart
failure, and no complex ventricular arrhythmias. (III-C: No Benefit)
Î Routine reassessment (<1 year) of LV function with technologies such
as echocardiography radionuclide imaging, CMR, or cardiac CT is NOT
recommended in patients with no change in clinical status and for
whom no change in therapy is contemplated. (III-C: No Benefit)
Stress Testing and Advanced Imaging in Patients With
Known SIHD Who Require Noninvasive Testing for Risk
Assessment
Risk Assessment in Patients Able to Exercise
Î Standard exercise ECG testing is recommended for risk assessment in
patients with SIHD who are able to exercise to an adequate workload
and have an interpretable ECG. (I-B)
Î The addition of either nuclear MPI or echocardiography to standard
exercise ECG testing is recommended for risk assessment in patients
with SIHD who are able to exercise to an adequate workload but have
an uninterpretable ECG not due to left bundle-branch block (LBBB) or
ventricular pacing. (I-B)
Î The addition of either nuclear MPI or echocardiography to standard
exercise ECG testing is reasonable for risk assessment in patients with
SIHD who are able to exercise to an adequate workload and have an
interpretable ECG. (IIa-B)
