Appropriate combinations of imaging modalities for structural, non-valvular heart disease were delineated for the first time by cardiology professional societies.
A companion to the 2017 Appropriate Use Criteria (AUC) for multimodality imaging in valvular heart disease, the new recommendations make a departure from evaluating single imaging modalities and turn to a diagnosis-based approach that considers multiple diagnostic options for each indication.
Transthoracic echocardiography (TTE) was rated “appropriate” more often than other modalities for the initial imaging of scenarios ranging from asymptomatic murmurs to severe symptoms in the new AUC published online in the Journal of the American College of Cardiology.
Initial and follow-up cardiac MRI and CT were deemed “may be appropriate” for specific cardiac indications and rated “appropriate” for the evaluation of the thoracic aorta.
Additionally, coronary angiography was found to be “appropriate” in assessing sustained ventricular tachycardia or ventricular fibrillation, noted John Doherty, MD, of Thomas Jefferson University, and colleagues on the writing group.
His group also rated the different imaging strategies that are possible before, during, and after patent foramen ovale and left atrial appendage occlusion interventions.
“The goal of this document is the determination of the range of modalities that may or may not be reasonable for specific indications rather than determination of a single best test for each indication or a rank order,” the authors emphasized.
What makes TTE the favored choice for the first evaluation of the patient is that it “provides a wealth of information on cardiac structure and function” without being invasive and without involving any radiation, Doherty told MedPage Today.
It is also less expensive than other testing modalities such as CT, MRI, and nuclear medicine studies, he added.
“Clinical benefit should always be considered first, and cost should be considered in relationship to these benefits when determining net value. For example, a procedure with moderate clinical efficacy for a given AUC indication should not be scored as more appropriate than a procedure with a high clinical efficacy solely because of lower cost,” the AUC noted.
The AUC was produced with representation from the American College of Cardiology AUC Task Force, the American Association for Thoracic Surgery, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Heart Rhythm Society, the Society for Cardiovascular Angiography and Interventions, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons.
The writing group is now working on the AUC for preoperative evaluation of noncardiac surgery, according to Doherty. “This is an area of variability in practice and confusion for clinicians.”
Doherty disclosed no conflicts of interest.