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(Circulation. 2008;117:1478-1497.)
© 2008 American Heart Association, Inc.

ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR Appropriateness Criteria

ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness Criteria for Stress Echocardiography^*

A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance: Endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine

STRESS ECHOCARDIOGRAPHY WRITING GROUP; Pamela S. Douglas, MD, MACC, FAHA, FASE, Chair; Bijoy Khandheria, MD, FASE, FACC; Raymond F. Stainback, MD, FACC, FASE; Neil J. Weissman, MD, FACC, FASE; TECHNICAL PANEL MEMBERS; Eric D. Peterson, MD, MPH, FACC, FAHA, Moderator; Robert C. Hendel, MD, FACC, FAHA, Methodology Liaison; Raymond F. Stainback, MD, FACC, FASE, Writing Group Liaison; Michael Blaivas, MD, RDMS, FACEP; Roger D. Des Prez, MD, FACC; Linda D. Gillam, MD, FACC, FAHA, FASE; Terry Golash, MD; Loren F. Hiratzka, MD, FACC, FAHA, FACS^||; William G. Kussmaul, MD, FACC^¶; Arthur J. Labovitz, MD, FACC, FAHA, FASE, FCCP; JoAnn Lindenfeld, MD, FACC^#; Frederick A. Masoudi, MD, MSPH, FACC; Paul H. Mayo, MD, FCCP^**; David Porembka, DO, FCCM; John A. Spertus, MD, MPH, FACC; L. Samuel Wann, MD, MACC; Susan E. Wiegers, MD, FACC, FASE; ACCF APPROPRIATENESS CRITERIA TASK FORCE; Ralph G. Brindis, MD, MPH, FACC, Chair; Pamela S. Douglas, MD, MACC, FAHA, FASE; Robert C. Hendel, MD, FACC, FAHA; Manesh R. Patel, MD; Eric D. Peterson, MD, MPH, FACC, FAHA; Michael J. Wolk, MD, MACC; Joseph M. Allen, MA

The American College of Cardiology Foundation (ACCF) and the American Society of Echocardiography (ASE) together with key specialty and subspecialty societies, conducted an appropriateness review for stress echocardiography. The review assessed the risks and benefits of stress echocardiography for several indications or clinical scenarios and scored them on a scale of 1 to 9 (based upon methodology developed by the ACCF to assess imaging appropriateness). The upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The midrange (4 to 6) indicates a clinical scenario for which the indication for a stress echocardiogram is uncertain. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Use of stress echocardiography for risk assessment in patients with coronary artery disease (CAD) was viewed favorably, while routine repeat testing and general screening in certain clinical scenarios were viewed less favorably. It is anticipated that these results will have a significant impact on physician decision making and performance, reimbursement policy, and will help guide future research.

Key Words: stress echocardiography • appropriateness criteria • cardiac imaging • coronary artery disease • diagnostic testing

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