• Abnormal ECG
  • evaluation = A
  • indication = Abnormal ECG
  • comment = Prior testing that is concerning for heart disease or structural abnormality including abnormal ECG are considered an appropriate indication.
• Abnormal prior cardiac testing (biomarkers, stress test, etc.)
  • evaluation = A
  • indication = Abnormal prior cardiac testing (biomarkers, stress test, etc.)
  • comment = Prior testing that is concerning for heart disease or structural abnormality including but not limited to chest X-ray, baseline scout images for stress echocardiogram, ECG, or cardiac biomarkers are considered an appropriate indication.
• Acute Coronary Syndrome (ACS)
• Adult Congenital Heart Disease
• Afib (Atrial fibrillation)
  • evaluation = A
  • indication = Afib (Atrial fibrillation)
  • comment = Sustained or nonsustained atrial fibrillation (afib) is an appropriate indication.
• Aortic Disease (aneurysm, dilation, etc.)
• Aortic Insufficiency (AI)
• Aortic Regurgitation (AR)
• Aortic Stenosis
• Arrhythmia
• Bradycardia (isolated, sinus)
• CAD / ASHD
  • evaluation = I
  • indication = CAD / ASHD
  • comment = CAD and/or ASHD is not considered an appropriate indication for an echo.
• Cardiac Mass
  • evaluation = A
  • indication = Cardiac Mass
  • comment = Suspected cardiac mass and/or cardiovascular source of embolus are considered an appropriate indication.
• Cardiac Transplant
  • evaluation = A
  • indication = Cardiac Transplant
  • comment = Monitoring for rejection in a cardiac transplant recipient and/or evaluating cardiac structure and function in a potential heart donor are all considered appropriate indications.
• Cardiac Trauma
• Cardiomyopathy
• Chemotherapy (cardiotoxic agents)
  • evaluation = A
  • indication = Chemotherapy (cardiotoxic agents)
  • comment = Baseline and serial re-evaluations in a patient undergoing therapy with cardiotoxic agents is considered an appropriate indication.
• Chest Pain
  • evaluation = A
  • indication = Chest Pain
  • comment = Symptoms or conditions potentially related to suspected cardiac etiology including chest pain is considered an appropriate criteria for echo.
• Device Evaluation
  • evaluation = A
  • indication = Device Evaluation
  • comment = Determining candidacy, optimization of ventricular assist device settings and re-evaluation for signs and symptoms suggestive of ventricular assist device-related complications are all considered appropriate indications.
• Endocarditis
• Embolism -(suspect cardiac etiology)
  • evaluation = A
  • indication = Embolism -(suspect cardiac etiology)
  • comment = Suspected cardiovascular source of embolus is considered an appropriate indication.
• Heart Failure
• Hypertension
• Hypotension / Hemodynamic instability
• LBBB
  • evaluation = I
  • indication = LBBB
  • comment = LBBB is not an appropriate indication.
• Light Headed/ presyncope
• LV Function
• Mitral Regurgitation (MR)
• Mitral Stenosis (MS)
• Murmur
• Myocardial Ischemia/Infarction (MI)
• PACs
• Palpitations
  • evaluation = A
  • indication = Palpitations
  • comment = Symptoms or conditions potentially related to suspected cardiac etiology, including palpitations, is considered an appropriate criteria for echo.
• Pericardial Conditions
• Pre-op evaluation
• Prosthetic Valves
• Pulmonary Embolism
• Pulmonary Hypertension
• Pulmonic Insufficiency (PI) Pulmonic Regurgitation
• Pulmonic Stenosis (PS)
• PVCs
• Respiratory Failure/ hypoxemia
• Shortness of breath
  • evaluation = A
  • indication = Shortness of breath
  • comment = Symptoms or conditions potentially related to suspected cardiac etiology, including shortness of breath, is considered an appropriate criteria for echo.
• SVT / VT
  • evaluation = A
  • indication = SVT / VT
  • comment = Sustained or nonsustained atrial fibrillation, SVT, or VT are appropriate indications.
• Syncope
  • evaluation = A
  • indication = Syncope
  • comment = Syncope, with or without symptoms or signs of cardiovascular disease, is considered an appropriate indication.
• TIA / stroke
  • evaluation = A
  • indication = TIA / stroke
  • comment = Symptoms or conditions potentially related to suspected cardiac etiology, including TIA / stroke, is considered an appropriate criteria for echo.
• Tricuspid Regurgitation (TR)
• Tricuspid Stenosis (TS)
• Ultrasound Guidance of cardiac procedure
  • evaluation = A
  • indication = Ultrasound Guidance of cardiac procedure
  • comment = Guidance of percutaneous noncoronary cardiac procedures including but not limited to pericardiocentesis, septal ablation, or right ventricular biopsy are all considered appropriate indications.
• Valvular Disease
• Other
  • evaluation = I
  • indication = Other
  • comment = A general non-specific indication is graded as an Inappropriate indication.

Aortic Stenosis

• Change in clinical status
  • evaluation = A
  • indication = Aortic Stenosis
  • comment = A change in clinical status is considered an appropriate indication to re-evaluate Aortic Stenosis.
• Routine Follow up echo
• Don't know
  • evaluation = UA
  • indication = Aortic Stenosis
  • comment = Unable to assess. A change in clinical status is an appropriate indication for AS but the appropriateness of routine surveillance of aortic stenosis is dependent on other factors.

Routine Follow up echo

• Mild stenosis
• Moderate to Severe Stenosis
• Don't Know Severity

Mild stenosis

• Last echo MORE than THREE years ago
  • evaluation = A
  • indication = Aortic Stenosis
  • comment = Routine surveillance (greater than 3 years) of mild valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than THREE years ago
  • evaluation = I
  • indication = Aortic Stenosis
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Aortic Stenosis
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular stenosis is dependent on the time since the last echo.

Moderate to Severe Stenosis

• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Aortic Stenosis
  • comment = Routine surveillance (greater than 1 year) of moderate to severe valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than ONE year ago
  • evaluation = I
  • indication = Aortic Stenosis
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Aortic Stenosis
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of moderate to severe valvular stenosis is dependent on the time since the last echo.

Arrhythmia

• Afib / SVT / VT
  • evaluation = A
  • indication = Arrhythmia
  • comment = Sustained or nonsustained afib, SVT, or VT are all categorized as appropriate indications.
• PACs (Premature Atrial Contraction)
• PVCs (Premature Ventricular Contractions)
• Bradycardia
  • evaluation = A
  • indication = Arrhythmia
  • comment =
• Don’t know
  • evaluation = UA
  • indication = Arrhythmia
  • comment = Not enough information to assess. Need to know what kind of arrhythmia in order to assess. (PACs, VT, bradycardia, etc.)

PVCs (Premature Ventricular Contractions)

• Infrequent
• Frequent or Exercised Induced
  • evaluation = A
  • indication = Arrhythmia
  • comment = Frequent PVCs or exercise-induced PVCs are considered an appropriate indication.
• Don’t know
  • evaluation = UA
  • indication = Arrhythmia
  • comment = Not enough information to assess the appropriateness. Unable to assess. Although frequent PVCs and exercise-induced PVCs are appropriate, infrequent PVCs without other evidence of heart disease is categorized as an inappropriate indication.

Infrequent

• Yes
  • evaluation = A
  • indication = Arrhythmia
  • comment = Infrequent PVCs without other evidence of heart disease is categorized as Inappropriate. In the presence of heart disease this would be considered an appropriate indication.
• No
  • evaluation = I
  • indication = Arrhythmia
  • comment = Infrequent PVCs without other evidence of heart disease is categorized as an 'Inappropriate' indication.
• Don't Know
  • evaluation = UA
  • indication = Arrhythmia
  • comment = Infrequent PVCs without other evidence of heart disease is categorized as Inappropriate. In the presence of heart disease this would be considered an appropriate indication. Unable to assess without knowledge of heart disease.

PACs (Premature Atrial Contraction)

• Yes
  • evaluation = A
  • indication = Arrhythmia
  • comment = PACs with other evidence of heart disease is an appropriate indication.
• No
  • evaluation = I
  • indication = Arrhythmia
  • comment = Infrequent PACs without other evidence of heart disease is categorized as an Inappropriate indication.
• Don’t know
  • evaluation = UA
  • indication = Arrhythmia
  • comment = Unable to assess without knowledge of whether there is evidence of heart disease. Infrequent PACs without other evidence of heart disease is categorized as an Inappropriate indication.

Bradycardia (isolated, sinus)

• Asymptomatic
  • evaluation = I
  • indication = Bradycardia (isolated, sinus)
  • comment = Unable to assess without additional knowledge of the type of arrythmia.
• Symptomatic
  • evaluation = A
  • indication = Bradycardia (isolated, sinus)
  • comment = Asymptomatic isolated sinus bradycardia is considered an inappropriate criteria for an echo
• Don’t know
  • evaluation = UA
  • indication = Bradycardia (isolated, sinus)
  • comment = Signs or symptoms would need to be suspicious for cardiac etiology in order to be considered an appropriate criteria for echo. Recommend writing indication as "Bradycardia with describe cardiac symptom"

Cardiomyopathy

• Initial
  • evaluation = A
  • indication = Cardiomyopathy
  • comment = Recommend writing indication as "Initial evaluation of known (restrictive, dilated, ischemic, hypertrophic) cardiomyopathy"
• Change in clinical status
  • evaluation = A
  • indication = Cardiomyopathy
  • comment = Recommend writing indication as "Cardiomyopathy -Follow up echo due to change in clinical status list change in clinical status)
• To guide therapy
  • evaluation = A
  • indication = Cardiomyopathy
  • comment = Recommend writing indication as "Cardiomyopathy -Follow up echo due to change in clinical status list change in clinical status)
• Screening
• Routine

Screening

• Yes
  • evaluation = A
  • indication = Cardiomyopathy
  • comment = Screening evaluation for structure and function in first degree relatives of patients with an inherited cardiomyopathy is considered an appropriate criteria for echo. Recommend writing indication as "Screening for Cardiomyopathy - 1st degree relative wit
• No
  • evaluation = I
  • indication = Cardiomyopathy
  • comment = Screening evaluation for cardiomyopathies are only considered an appropriate criteria for echo in patients with a first degree relative with an inherited cardiomyopathy.
• Don't Know
  • evaluation = UA
  • indication = Cardiomyopathy
  • comment = Unable to assess. Screening evaluation for cardiomyopathies are only considered an appropriate criteria in patients with a first degree relative with an inherited cardiomyopathy.

Routine

• Yes
  • evaluation = I
  • indication = Cardiomyopathy
  • comment = Routine surveillance (less than a year) of known cardiomyopathy without a change in clinical status is considered an inappropriate criteria for echo.
• No
  • evaluation = U
  • indication = Cardiomyopathy
  • comment = Routine surveillance (more than one year) of known cardiomyopathy without a change in clinical status is considered an uncertain criteria for echo.
• Don't Know
  • evaluation = UA
  • indication = Cardiomyopathy
  • comment = Unable to assess without knowledge of the date of the last echo.

Heart Failure

• Initial
  • evaluation = A
  • indication = Heart Failure
  • comment = Initial evaluation of known or suspected HF (systolic or diastolic) based on symptoms, signs, or abnormal test results is considered an appropriate indication.
• Change of clinical status
• To guide therapy
  • evaluation = A
  • indication = Heart Failure
  • comment = Re-evaluation of known HF (systolic or diastolic) to guide therapy is considered an appropriate indication.
• Routine Echo

Change of clinical status

• Yes
  • evaluation = U
  • indication = Heart Failure
  • comment = Re-evaluation of known HF (systolic or diastolic) with a change in clinical status or cardiac exam with a clear precipitating change in medication or diet is categorized as 'Uncertain'.
• No
  • evaluation = A
  • indication = Heart Failure
  • comment = Re-evaluation of known HF (systolic or diastolic) with a change in clinical status or cardiac exam without a clear precipitating change in medication or diet is considered an appropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Heart Failure
  • comment = The appropriateness of Re-evaluation of known Heart Failure (with a change in clinical status) is dependent on whether or not there is a clear precipitating change in medication or diet. Unable to assess without this information.

Routine Echo

• Yes
  • evaluation = I
  • indication = Heart Failure
  • comment = Routine surveillance (<1 y) of HF (systolic or diastolic) when there is no change in clinical status or cardiac exam is considered Inappropriate.
• No
  • evaluation = U
  • indication = Heart Failure
  • comment = Routine surveillance (more than 1 year) of Heart Failure (systolic or diastolic) when there is no change in clinical status or cardiac exam is categorized as 'Uncertain'.
• Don't Know
  • evaluation = UA
  • indication = Heart Failure
  • comment = The appropriateness of routine surveillance of HF (systolic or diastolic) when there is no change in clinical status or cardiac exam is based on how recently the prior echo was performed. Unable to assess without knowledge of date of prior echo.

Hypertension

• Initial evaluation, suspected hypertensive heart disease
  • evaluation = A
  • indication = Hypertension
  • comment = Initial evaluation of suspected hypertensive heart disease is considered an appropriate indication.
• Routine evaluation of hypertension
• Known hypertensive heart disease
• Don't know
  • evaluation = UA
  • indication = Hypertension
  • comment = Unable to assess without additional knowledge. Initial evaluation with suspicion of hypertensive heart disease is appropriate while routine evaluation of systemic hypertension without signs or symptoms of hypertensive heart disease is inappropriate.

Routine evaluation of hypertension

• Yes
  • evaluation = A
  • indication = Hypertension
  • comment = Routine evaluation of systemic hypertension without symptoms or signs of hypertensive heart disease is considered an inappropriate indication. In the presence of signs or symptoms this is an appropriate indication.
• No
  • evaluation = I
  • indication = Hypertension
  • comment = Routine evaluation of systemic hypertension without symptoms or signs of hypertensive heart disease is considered an inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Hypertension
  • comment = Unable to assess. Routine evaluation of systemic hypertension without symptoms or signs of hypertensive heart disease is considered an inappropriate indication.

Known hypertensive heart disease

• Yes
  • evaluation = A
  • indication = Hypertension
  • comment = The appropriateness of re-evaluation of known hypertensive heart disease without a change in clinical status or cardiac exam is categorized as 'Uncertain'; with a change of clinical status this would be considered appropriate.
• No
  • evaluation = U
  • indication = Hypertension
  • comment = The appropriateness of an echo for re-evaluation of known hypertensive heart disease without a change in clinical status or cardiac exam is categorized as 'Uncertain'.
• Don't know
  • evaluation = UA
  • indication = Hypertension
  • comment = Unable to assess. The appropriateness of re-evaluation of known hypertensive heart disease without a change in clinical status or cardiac exam is categorized as 'Uncertain'.

Light Headed/ presyncope

• No other signs of cardiovascular disease
  • evaluation = I
  • indication = Light Headed/ presyncope
  • comment = Lightheadedness / presyncope when there are no other symptoms or signs of cardiovascular disease is considered an inappropriate indication.
• Clinical symptoms consistent with a cardiac diagnosis (for example: Aortic stenosis, hypertrophic cardiomyopathy, heart failure, etc )
  • evaluation = A
  • indication = Light Headed/ presyncope
  • comment = This is considered an appropriate indication in the presence of clinical symptoms or signs consistent with a cardiac diagnosis known to cause lightheadedness/presyncope.
• Don’t know
  • evaluation = UA
  • indication = Light Headed/ presyncope
  • comment = The appropriateness of an echo for lightheadedness is dependent on whether clinical symptoms or signs consistent with a cardiac diagnosis known to cause lightheadedness is present. Unable to assess without this information.

LV Function

• Signs or symptoms of cardiovascular disease
  • evaluation = A
  • indication = LV Function
  • comment = Initial evaluation of ventricular function with signs and symptoms of cardiovascular disease is an appropriate indication. List the signs and symptoms in the indication.
• Abnormal results of prior testing of LV function (CT, SPECT, etc.)
  • evaluation = A
  • indication = LV Function
  • comment = Evaluation of LV function when prior testing was abnormal is considered an appropriate indication. List the abnormal findings in the indication.
• Change in clinical status
  • evaluation = A
  • indication = LV Function
  • comment = Routine surveillance of ventricular function with known CAD and no change in clinical status or cardiac exam is categorized as an inappropriate indication. If a change of clinical status is present, this is considered an appropriate indication.
• None of the above
  • evaluation = I
  • indication = LV Function
  • comment = The indication of LVF requires signs and symptoms of cardiovascular disease and/or change in clinical status in order to be considered an appropriate indication.
• Don’t know
  • evaluation = UA
  • indication = LV Function
  • comment = Unable to assess as the indication of LVF requires signs and symptoms of cardiovascular disease and/or change in clinical status in order to be considered an appropriate indication.

Mitral Regurgitation (MR)

• Change in clinical status
  • evaluation = A
  • indication = Mitral Regurgitation (MR)
  • comment = A change in clinical status is considered an appropriate indication to re-evaluate Mitral Regurgitation.
• Routine echo
• Don't know
  • evaluation = UA
  • indication = Mitral Regurgitation (MR)
  • comment = Unable to assess. A change in clinical status is an appropriate indication for MR but the appropriateness of routine surveillance of MR is dependent on other factors.

Routine echo

• Mild regurgitation
• Moderate or Severe Regurgitation
• Don't Know severity
  • evaluation = UA
  • indication = Mitral Regurgitation (MR)
  • comment = Unable to assess as the appropriateness of an echo for Mitral Regurgitation without a change in clinical status is dependent on the severity of the Mitral Regurgitation.

Moderate or Severe Regurgitation

• Last echo LESS than ONE year ago
  • evaluation = U
  • indication = Mitral Regurgitation (MR)
  • comment = Routine surveillance (less than one year) of moderate or severe valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Mitral Regurgitation (MR)
  • comment = Routine surveillance (more than one year) of moderate or severe valvular regurgitation without change in clinical status is considered an appropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Mitral Regurgitation (MR)
  • comment = Unable to assess. The appropriateness of routine surveillance of moderate to severe valvular regurgitation is dependent on the time since the last echo.

Mild regurgitation

• Last echo MORE than THREE years ago
  • evaluation = U
  • indication = Mitral Regurgitation (MR)
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo LESS than THREE years
  • evaluation = I
  • indication = Mitral Regurgitation (MR)
  • comment = Routine surveillance (less than 3 years) of mild valvular regurgitation without a change in clinical status is considered an Inappropriate indication.
• Don't Know

Myocardial Ischemia/Infarction (MI)

• Acute Chest Pain
  • evaluation = A
  • indication = Myocardial Ischemia/Infarction (MI)
  • comment = Acute chest pain with suspected MI and nondiagnostic ECG when a resting echocardiogram can be performed during pain is considered an appropriate indication.
• Without Chest Pain but with other features of an ischemic equivalent or lab markes indicative of ongoing MI.
  • evaluation = A
  • indication = Myocardial Ischemia/Infarction (MI)
  • comment = Evaluation of a patient without chest pain but with other features of an ischemic equivalent or laboratory markers indicative of ongoing MI is considered an appropriate indication.
• Suspected complication of MI (for example: acute MR, ruptured free wall, HF, thrombus, etc.)
  • evaluation = A
  • indication = Myocardial Ischemia/Infarction (MI)
  • comment = Suspected complication of myocardial ischemia/infarction, (including but not limited to acute mitral regurgitation, ventricular septal defect, free-wall rupture/tamponade, shock, right ventricular involvement, HF, or thrombus) is considered an appropriate
• None of the above
  • evaluation = UA
  • indication = Myocardial Ischemia/Infarction (MI)
  • comment = The indication of MI is only considered Appropriate in the presence of acute chest pain, other features of ischemic equivalent, lab markers and/or suspected complications.
• Don’t Know
  • evaluation = UA
  • indication = Myocardial Ischemia/Infarction (MI)
  • comment = The indication of MI is only considered Appropriate in the presence of acute chest pain, other features of ischemic equivalent, lab markers and/or suspected complications. Unable to assess without knowledge of these additional findings.

Murmur

• Initial evaluation
• Re-evaluation
• Don't Know
  • evaluation = UA
  • indication = Murmur
  • comment = To assess the appropriateness of the study, knowledge of whether this is an initial study or re-evaluation is required. Unable to assess.

Initial evaluation

• Yes
  • evaluation = A
  • indication = Murmur
  • comment = Initial evaluation with a reasonable suspicion of valvular or structural heart disease is an appropriate indication. Initial evaluation when there are no other symptoms or signs of valvular or structural heart disease is an inappropriate criteria.
• No
  • evaluation = I
  • indication = Murmur
  • comment = Initial evaluation when there are no other symptoms or signs of valvular or structural heart disease and when there is not a reasonable suspicion of valvular or structural heart disease is categorized as an inappropriate indication.
• Don't know
  • evaluation = UA
  • indication = Murmur
  • comment = Unable to assess, as the appropriateness is dependent on signs or symptoms of structural heart disease.

Re-evaluation

• Yes
  • evaluation = A
  • indication = Murmur
  • comment = Re-evaluation is considered an appropriate indication with a change in clinical status or cardiac exam or to guide therapy.
• No
  • evaluation = I
  • indication = Murmur
  • comment = Re-evaluation is only considered an appropriate indication with a change in clinical status or cardiac exam or to guide therapy.
• Don't know
  • evaluation = UA
  • indication = Murmur
  • comment = Unable to assess as re-evaluation is only considered an appropriate indication with a change in clinical status or cardiac exam or to guide therapy.

Pre-op evaluation

• Cardiovascular signs and symptoms
  • evaluation = A
  • indication = Pre-op evaluation
  • comment = Routine perioperative evaluation of ventricular function with no symptoms or signs of cardiovascular disease is considered Inappropriate. Symptoms or conditions potentially related to suspected cardiac etiology is considered an appropriate indication.
• Non cardiac solid organ transplant
  • evaluation = U
  • indication = Pre-op evaluation
  • comment = Routine perioperative evaluation of cardiac structure and function prior to noncardiac solid organ transplantation is considered of Uncertain appropriateness.
• None of the above
  • evaluation = I
  • indication = Pre-op evaluation
  • comment = Routine perioperative evaluation of ventricular function with no symptoms or signs of cardiovascular disease is considered inappropriate.
• Don’t know
  • evaluation = UA
  • indication = Pre-op evaluation
  • comment = Routine perioperative evaluation of ventricular function with no symptoms or signs of cardiovascular disease is considered inappropriate. Unable to assess without knowledge of signs and symptoms.

Pulmonary Hypertension

• Initial
  • evaluation = A
  • indication = Pulmonary Hypertension
  • comment = Evaluation of suspected pulmonary hypertension including evaluation of right ventricular function and estimated pulmonary artery pressure is considered an appropriate indication.
• Change of clinical status and/or to guide therapy
  • evaluation = A
  • indication = Pulmonary Hypertension
  • comment = Re-evaluation of known pulmonary hypertension if change in clinical status or cardiac exam or to guide therapy is considered an appropriate indication.
• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Pulmonary Hypertension
  • comment = Routine surveillance of known pulmonary hypertension without change in clinical status or cardiac exam is considered an appropriate indication when the prior echo was more than one year ago.
• None of the above
  • evaluation = I
  • indication = Pulmonary Hypertension
  • comment = Routine surveillance of known pulmonary hypertension without change in clinical status or cardiac exam is considered an inappropriate indication is considered an inappropriate indication when the prior echo was performed less than one year ago.
• Don’t know
  • evaluation = UA
  • indication = Pulmonary Hypertension
  • comment = Unable to assess without additional information. The appropriateness of routine surveillance of known pulmonary hypertension without change in clinical status or cardiac exam is dependent on the time frame since the prior echo.

Valvular Disease

• Change in clinical status
  • evaluation = A
  • indication = Valvular Disease
  • comment = A change in clinical status is considered an appropriate indication to re-evaluate valvular disease.
• Routine echo
• Don't know
  • evaluation = UA
  • indication = Valvular Disease
  • comment = Unable to assess. A change in clinical status is an appropriate indication for valvular heart disease but the appropriateness of routine surveillance of valvular disease is dependent on other factors.

Routine echo

• Valvular Regurgitation
• Valvular Stenosis

Valvular Regurgitation

• Mild regurgitation
• Moderate or Severe Regurgitation
• Don't Know severity

Moderate or Severe Regurgitation

• Last echo LESS than ONE year ago
  • evaluation = U
  • indication = Valvular Disease
  • comment = Routine surveillance (less than one year) of moderate or severe valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Valvular Disease
  • comment = Routine surveillance (more than one year) of moderate or severe valvular regurgitation without change in clinical status is considered an appropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Valvular Disease
  • comment = Unable to assess. The appropriateness of routine surveillance of moderate to severe regurgitation is dependent on the time since the last echo.

Mild regurgitation

• Last echo MORE than THREE years ago
  • evaluation = U
  • indication = Valvular Disease
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo LESS than THREE years
  • evaluation = I
  • indication = Valvular Disease
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Don't Know
  • evaluation = UA
  • indication = Valvular Disease
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular regurgitation is dependent on the time since the last echo.

Valvular Stenosis

• Mild stenosis
• Moderate to Severe Stenosis
• Don't Know Severity
  • evaluation = UA
  • indication = Valvular Disease
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of stenosis is dependent on the severity of the stenosis.

Mild stenosis

• Last echo MORE than THREE years ago
  • evaluation = A
  • indication = Valvular Disease
  • comment = Routine surveillance (greater than 3 years) of mild valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than THREE years ago
  • evaluation = I
  • indication = Valvular Disease
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Valvular Disease
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular stenosis is dependent on the time since the last echo.

Moderate to Severe Stenosis

• Last echo MORE than ONE year ago
• Last echo LESS than ONE year ago
• Don't Know
  • evaluation = UA
  • indication = Valvular Disease
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of moderate to severe valvular stenosis is dependent on the time since the last echo.

Adult Congenital Heart Disease

• Initial echo
  • evaluation = A
  • indication = Adult Congenital Heart Disease
  • comment = Initial evaluation of known or suspected adult congenital heart disease is considered an appropriate indication.
• Change in Clinical Status
  • evaluation = A
  • indication = Adult Congenital Heart Disease
  • comment = Routine surveillance is only considered uncertain without a change in clinical status or cardiac exam.
• Guide therapy
  • evaluation = A
  • indication = Adult Congenital Heart Disease
  • comment =
• Routine echo after repair of congenital defect
• None of the Above
  • evaluation = I
  • indication = Adult Congenital Heart Disease
  • comment = Prior to repair of congenital heart disease, the only appropriate indications for an echo include the initial echo, change in clinical status and/or to guide therapy.
• Don’t Know
  • evaluation = UA
  • indication = Adult Congenital Heart Disease
  • comment =

Routine echo after repair of congenital defect

• Residual structural or hemodynamic abnormality
  • evaluation = A
  • indication = Adult Congenital Heart Disease
  • comment =
• Change in clinical status
  • evaluation = A
  • indication = Adult Congenital Heart Disease
  • comment = Known adult congenital heart disease with a change in clinical status or cardiac exam is considered an appropriate indication.
• Complete repair follow up
• Incomplete Repair / Palliative

Complete repair follow up

• Less than 2 years ago
  • evaluation = I
  • indication = Adult Congenital Heart Disease
  • comment = Routine surveillance of adult congenital heart disease following complete repair, without a residual abnormality and/or without change in clinical status is categorized as an Inappropriate indication if the last echo was performed less than two years ago.
• More than 2 years ago
  • evaluation = U
  • indication = Adult Congenital Heart Disease
  • comment = Routine surveillance of adult congenital heart disease following complete repair, without a residual abnormality and/or without change in clinical status is categorized as an 'Uncertain' criteria if the last echo was performed more than two years ago.
• Don’t Know
  • evaluation = UA
  • indication = Adult Congenital Heart Disease
  • comment = The appropriateness of a routine echo following repair of congenital heart disease is dependent on the time frame since the last prior echo, without this information the appropriateness is unable to assess.

Incomplete Repair / Palliative

• Less than 1 years ago
  • evaluation = U
  • indication = Adult Congenital Heart Disease
  • comment = Routine surveillance of adult congenital heart disease following incomplete repair or palliative repair, without a change in clinical status is categorized as an 'Uncertain' criteria if the last echo was performed less than one year ago.
• More than 1 year ago
  • evaluation = A
  • indication = Adult Congenital Heart Disease
  • comment = Routine surveillance of adult congenital heart disease following incomplete repair or palliative repair, without a change in clinical status is categorized an appropriate indication if the last echo was performed more than one year ago.
• Don’t Know
  • evaluation = UA
  • indication = Adult Congenital Heart Disease
  • comment = The appropriateness of a routine echo following repair of congenital heart disease is dependent on the time frame since the last prior echo, without this information the appropriateness is unable to assess.

Aortic Disease (aneurysm, dilation, etc.)

• Suspected aortic dilatation (connective tissue disease)
  • evaluation = A
  • indication = Aortic Disease (aneurysm, dilation, etc.)
  • comment = Evaluation of the ascending aorta in the setting of a known or suspected connective tissue disease or genetic condition that predisposes to aortic aneurysm or dissection (e.g., Marfan syndrome) is considered an appropriate indication.
• Known dilatation - Re-evaluation
• Don’t Know
  • evaluation = UA
  • indication = Aortic Disease (aneurysm, dilation, etc.)
  • comment = Unable to assess. Routine echo for known ascending aortic dilation or history of aortic dissection without a change in clinical status when findings would not change management is categorized as an inappropriate indication.

Known dilatation - Re-evaluation

• Baseline rate or Excessive rate of expansion
  • evaluation = A
  • indication = Aortic Disease (aneurysm, dilation, etc.)
  • comment = Re-evaluation of known ascending aortic dilation or history of aortic dissection to establish a baseline rate of expansion or when the rate of expansion is excessive is considered an appropriate indication.
• Change in clinical status or to guide therapy
  • evaluation = A
  • indication = Aortic Disease (aneurysm, dilation, etc.)
  • comment = Re-evaluation of known ascending aortic dilation or history of aortic dissection with a change in clinical status or cardiac exam or when findings may alter management or therapy is considered an appropriate indication.
• None of the above
  • evaluation = I
  • indication = Aortic Disease (aneurysm, dilation, etc.)
  • comment = Routine re-evaluation for surveillance of known ascending aortic dilation or history of aortic dissection without a change in clinical status or cardiac exam when findings would not change management or therapy is considered an inappropriate indication.
• Don't know
  • evaluation = UA
  • indication = Aortic Disease (aneurysm, dilation, etc.)
  • comment = Unable to assess. Routine echo for known ascending aortic dilation or history of aortic dissection without a change in clinical status when findings would not change management is categorized as an inappropriate indication.

Cardiac Trauma

• Possible or susptected valve injury, cardiac injury or pericardial effusion
  • evaluation = A
  • indication = Cardiac Trauma
  • comment = Severe deceleration injury or chest trauma when valve injury, pericardial effusion, or cardiac injury are possible or suspected are all considered appropriate indications.
• ECG Changes
  • evaluation = A
  • indication = Cardiac Trauma
  • comment = Routine evaluation in the setting of mild chest trauma is only considered inappropriate with no electrocardiographic changes or biomarker elevation.
• Biomarkers elevated
  • evaluation = A
  • indication = Cardiac Trauma
  • comment = Routine evaluation in the setting of mild chest trauma is only considered inappropriate with no electrocardiographic changes or biomarker elevation.
• None of the Above
  • evaluation = I
  • indication = Cardiac Trauma
  • comment = In the absence of severe deceleration injury and suspected valve/cardiac injury or if there are no electrocardiographic changes or biomarker elevation, routine evaluation in the setting of mild chest trauma is considered inappropriate.
• Don’t Know
  • evaluation = UA
  • indication = Cardiac Trauma
  • comment = Unable to assess. In the absence of severe deceleration injury and suspected valve/cardiac injury or if there are no electrocardiographic changes or biomarker elevation, routine evaluation in the setting of mild chest trauma is considered inappropriate.

Endocarditis

• Initial evaluation of suspected endocarditis
  • evaluation = A
  • indication = Endocarditis
  • comment = Initial evaluation of suspected infective endocarditis with positive blood cultures or a new murmur is considered an appropriate indication.
• Re-evaluation
  • evaluation = A
  • indication = Endocarditis
  • comment = Initial evaluation of suspected infective endocarditis with positive blood cultures or a new murmur is considered an appropriate indication.
• Don't know
  • evaluation = UA
  • indication = Endocarditis
  • comment = Unable to assess, the appropriateness of the test is dependent on whether or not the test is for initial evaluation or re-evaluation.

• Pathogen typically not associated with infective endocarditis
• Documented NON-endovascular source of infection
• None of the Above
• Don't know

Initial evaluation of suspected endocarditis

• Positive blood cultures
  • evaluation = A
  • indication = Endocarditis
  • comment = Initial evaluation of suspected infective endocarditis with positive blood cultures is an appropriate indication.
• New murmur
  • evaluation = A
  • indication = Endocarditis
  • comment = Initial evaluation of suspected infective endocarditis with a new murmur is considered an appropriate indication.
• None of the above
  • evaluation = I
  • indication = Endocarditis
  • comment = Only positive blood cultures and new murmurs are appropriate indications for initial evaluation of suspected endocarditis.
• Don't Know
  • evaluation = UA
  • indication = Endocarditis
  • comment = Unable to assess, in order to assess appropriateness more information is needed.

Re-evaluation

• High risk for progression or complications
  • evaluation = A
  • indication = Endocarditis
  • comment = Re-evaluation of infective endocarditis at high risk for progression or complication is considered an appropriate indication.
• Change in clinical status or cardiac exam
  • evaluation = A
  • indication = Endocarditis
  • comment = Re-evaluation of infective endocarditis with a change in clinical status or cardiac exam is considered an appropriate indication.
• Contemplating change in management
  • evaluation = A
  • indication = Endocarditis
  • comment = Routine surveillance of uncomplicated infective endocarditis when a change in management is contemplated is appropriate.
• None of the above
  • evaluation = I
  • indication = Endocarditis
  • comment = Routine surveillance of uncomplicated infective endocarditis when no change in management is contemplated is considered an Inappropriate indication.
• Don't Know

Hypotension / Hemodynamic instability

• cardiac etiology suspected
  • evaluation = A
  • indication = Hypotension / Hemodynamic instability
  • comment = Hypotension or hemodynamic instability of uncertain or suspected cardiac etiology is an appropriate indication.
• Assessment of volume in the critically ill patient
  • evaluation = U
  • indication = Hypotension / Hemodynamic instability
  • comment = Assessment of volume status in a critically ill patient is graded as an Uncertain Indication.
• None of the Above
  • evaluation = I
  • indication = Hypotension / Hemodynamic instability
  • comment = Hypotension or hemodynamic instability of uncertain or suspected cardiac etiology are the only appropriate indications for Hypotension.
• Don’t Know
  • evaluation = UA
  • indication = Hypotension / Hemodynamic instability
  • comment = Unable to assess, not enough information to determine if the indication is appropriate.

Pericardial Conditions

• Suspected pericardial effusion
  • evaluation = A
  • indication = Pericardial Conditions
  • comment = Suspected pericardial conditions are considered an appropriate indication.
• Change in Clinical Status
  • evaluation = A
  • indication = Pericardial Conditions
  • comment = Routine surveillance of known small pericardial effusion is only considered appropriate with a change in clinical status.
• Manage Therapy
  • evaluation = A
  • indication = Pericardial Conditions
  • comment = Re-evaluation of known pericardial effusion to guide management or therapy is an appropriate indication.
• Guide Pericardiocentisis
  • evaluation = A
  • indication = Pericardial Conditions
  • comment = Guidance of percutaneous noncoronary cardiac procedures including but not limited to pericardiocentesis, septal ablation, or right ventricular biopsy are all appropriate indications.
• None of the Above
  • evaluation = I
  • indication = Pericardial Conditions
  • comment = Suspected pericardial conditions, guidance of percutaneous noncoronary cardiac procedures and re-evaluation to guide management or therapy are the only indications for pericardial conditions that are considered appropriate.
• Don’t Know
  • evaluation = UA
  • indication = Pericardial Conditions
  • comment = Unable to assess, not enough information to determine if the indication is appropriate.

Prosthetic Valves

• Initial Post-Op
  • evaluation = A
  • indication = Prosthetic Valves
  • comment = Initial postoperative evaluation of prosthetic valve for establishment of baseline is considered an appropriate indication.
• Susptected valve dysfunction
  • evaluation = A
  • indication = Prosthetic Valves
  • comment = Evaluation of prosthetic valve with suspected dysfunction is an appropriate indication.
• Change in clinical status
  • evaluation = A
  • indication = Prosthetic Valves
  • comment = Evaluation of prosthetic valve with a change in clinical status or cardiac exam is an appropriate indication.
• Manage therapy
  • evaluation = A
  • indication = Prosthetic Valves
  • comment = Re-evaluation of known prosthetic valve dysfunction when it would change management or guide therapy is considered an appropriate indication.
• Routine Echo
• Don’t Know
  • evaluation = UA
  • indication = Prosthetic Valves
  • comment = Unable to assess, not enough information to determine if the indication is appropriate.

Routine Echo

• Last echo less than 3 years ago
  • evaluation = I
  • indication = Prosthetic Valves
  • comment = Routine surveillance (less than three years after valve implantation) of prosthetic valve if no known or suspected valve dysfunction is considered an inappropriate indication.
• Last echo greater than 3 years ago
  • evaluation = A
  • indication = Prosthetic Valves
  • comment = Routine surveillance (greater than three years after valve implantation) of prosthetic valve if no known or suspected valve dysfunction is considered an appropriate indication.

Pulmonary Embolism

• Initial to establish diagnosis
  • evaluation = I
  • indication = Pulmonary Embolism
  • comment = Suspected pulmonary embolism in order to establish diagnosis is considered an Inappropriate indication.
• Guide Therapy
  • evaluation = A
  • indication = Pulmonary Embolism
  • comment = Known acute pulmonary embolism to guide therapy (e.g., thrombectomy and thrombolytics) is considered an appropriate indication.
• Routine
• Don't know
  • evaluation = UA
  • indication = Pulmonary Embolism
  • comment = Unable to assess, not enough information to determine if the indication is appropriate.

Routine

• Normal right ventricular function and pulmonary artery systolic pressure
  • evaluation = I
  • indication = Pulmonary Embolism
  • comment = Routine surveillance of prior pulmonary embolism with normal right ventricular function and pulmonary artery systolic pressure is an Inappropriate indication.
• Assesment of change in RV function and pulmonary artery pressure
  • evaluation = A
  • indication = Pulmonary Embolism
  • comment = Re-evaluation of known pulmonary embolism after thrombolysis or thrombectomy for assessment of change in right ventricular function and/or pulmonary artery pressure are appropriate indications.
• Don’t Know
  • evaluation = UA
  • indication = Pulmonary Embolism
  • comment = Unable to assess, not enough information to establish if the indication is appropriate.

Pulmonic Insufficiency (PI) Pulmonic Regurgitation

• Change in clinical status
  • evaluation = A
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = A change in clinical status is considered an appropriate indication to re-evaluate Pulmonic Insufficiency/Regurgitation.
• Routine Follow up echo
• Don't know
  • evaluation = UA
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = Unable to assess. A change in clinical status is an appropriate indication for PI but the appropriateness of routine surveillance of pulmonic insufficiency is dependent on other factors.

Routine Follow up echo

• Mild regurgitation
• Moderate or Severe Regurgitation
• Don't Know severity

Moderate or Severe Regurgitation

• Last echo LESS than ONE year ago
  • evaluation = U
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = Routine surveillance (less than one year) of moderate or severe valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = Routine surveillance (more than one year) of moderate or severe valvular regurgitation without change in clinical status is considered an appropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = Unable to assess. The appropriateness of routine surveillance of moderate to severe valvular regurgitation is dependent on the time since the last echo.

Mild regurgitation

• Last echo MORE than THREE years ago
  • evaluation = U
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo LESS than THREE years
  • evaluation = I
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = Routine surveillance (less than 3 years) of mild valvular regurgitation without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Pulmonic Insufficiency (PI) Pulmonic Regurgitation
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular regurgitation is dependent on the time since the last echo.

Respiratory Failure/ hypoxemia

• Unknown etiology
  • evaluation = A
  • indication = Respiratory Failure/ hypoxemia
  • comment = Respiratory failure or hypoxemia of uncertain etiology is considered an appropriate indication.
• Suspected cardiac etiology
  • evaluation = A
  • indication = Respiratory Failure/ hypoxemia
  • comment = Respiratory failure or hypoxemia when a cardiac etiology of respiratory failure has been established is an appropriate indication.
• Noncardiac etiology
  • evaluation = U
  • indication = Respiratory Failure/ hypoxemia
  • comment = Respiratory failure or hypoxemia when a noncardiac etiology of respiratory failure has been established is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Respiratory Failure/ hypoxemia
  • comment = Unable to assess, not enough information to establish if the indication is appropriate.

Tricuspid Stenosis (TS)

• Change in clinical status
  • evaluation = A
  • indication = Tricuspid Stenosis (TS)
  • comment =
• Routine Follow up echo
• Don't know
  • evaluation = UA
  • indication = Tricuspid Stenosis (TS)
  • comment = Unable to assess, not enough information. A change in clinical status is an appropriate indication for valvular stenosis but the appropriateness of routine surveillance of stenosis is dependent on other factors.

Routine Follow up echo

• Mild stenosis
• Moderate to Severe Stenosis
• Don't Know Severity

Mild stenosis

• Last echo MORE than THREE years ago
  • evaluation = A
  • indication = Tricuspid Stenosis (TS)
  • comment = Routine surveillance (greater than 3 years) of mild valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than THREE years ago
  • evaluation = I
  • indication = Tricuspid Stenosis (TS)
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Tricuspid Stenosis (TS)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular stenosis is dependent on the time since the last echo.

Moderate to Severe Stenosis

• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Tricuspid Stenosis (TS)
  • comment = Routine surveillance (greater than 1 year) of moderate to severe valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than ONE year ago
  • evaluation = I
  • indication = Tricuspid Stenosis (TS)
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Tricuspid Stenosis (TS)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of moderate to severe valvular stenosis is dependent on the time since the last echo.

Pulmonic Stenosis (PS)

• Change in clinical status
  • evaluation = A
  • indication = Pulmonic Stenosis (PS)
  • comment = A change in clinical status is considered an appropriate indication to re-evaluate Pulmonic Stenosis.
• Routine Follow up echo
• Don't know
  • evaluation = UA
  • indication = Pulmonic Stenosis (PS)
  • comment = Unable to assess, not enough information. A change in clinical status is an appropriate indication for valvular stenosis but the appropriateness of routine surveillance of stenosis is dependent on other factors

Routine Follow up echo

• Mild stenosis
• Moderate to Severe Stenosis
• Don't Know Severity

Mild stenosis

• Last echo MORE than THREE years ago
  • evaluation = A
  • indication = Pulmonic Stenosis (PS)
  • comment = Routine surveillance (greater than 3 years) of mild valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than THREE years ago
  • evaluation = I
  • indication = Pulmonic Stenosis (PS)
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Pulmonic Stenosis (PS)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular stenosis is dependent on the time since the last echo.

Moderate to Severe Stenosis

• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Pulmonic Stenosis (PS)
  • comment = Routine surveillance (greater than 1 year) of moderate to severe valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than ONE year ago
  • evaluation = I
  • indication = Pulmonic Stenosis (PS)
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Pulmonic Stenosis (PS)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of moderate to severe valvular stenosis is dependent on the time since the last echo.

Aortic Insufficiency (AI)

• Change in clinical status
  • evaluation = A
  • indication = Aortic Insufficiency (AI)
  • comment = A change in clinical status is considered an appropriate indication to re-evaluate Aortic Insufficiency.
• Routine echo
• Don't know
  • evaluation = UA
  • indication = Aortic Insufficiency (AI)
  • comment = Unable to assess. A change in clinical status is an appropriate indication for AI but the appropriateness of routine surveillance of aortic insufficiency is dependent on other factors.

Routine echo

• Mild regurgitation
• Moderate or Severe Regurgitation
• Don't Know severity
  • evaluation = UA
  • indication = Aortic Insufficiency (AI)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of regurgitation is dependent on the severity of the regurgitation.

Moderate or Severe Regurgitation

• Last echo LESS than ONE year ago
  • evaluation = U
  • indication = Aortic Insufficiency (AI)
  • comment = Routine surveillance (less than one year) of moderate or severe valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Aortic Insufficiency (AI)
  • comment = Routine surveillance (more than one year) of moderate or severe valvular regurgitation without change in clinical status is considered an appropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Aortic Insufficiency (AI)
  • comment = Unable to assess. The appropriateness of routine surveillance of moderate to severe valvular regurgitation is dependent on the time since the last echo.

Mild regurgitation

• Last echo MORE than THREE years ago
  • evaluation = U
  • indication = Aortic Insufficiency (AI)
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo LESS than THREE years
  • evaluation = I
  • indication = Aortic Insufficiency (AI)
  • comment = Routine surveillance (less than 3 years) of mild valvular regurgitation without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Aortic Insufficiency (AI)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular regurgitation is dependent on the time since the last echo.

Aortic Regurgitation (AR)

• Change in clinical status
  • evaluation = A
  • indication = Aortic Regurgitation (AR)
  • comment = A change in clinical status is considered an appropriate indication to re-evaluate Aortic Regurgitation.
• Routine echo
• Don't know
  • evaluation = UA
  • indication = Aortic Regurgitation (AR)
  • comment = Unable to assess. A change in clinical status is an appropriate indication for AR but the appropriateness of routine surveillance of aortic regurgitation is dependent on other factors.

Routine echo

• Mild regurgitation
• Moderate or Severe Regurgitation
• Don't Know severity

Moderate or Severe Regurgitation

• Last echo LESS than ONE year ago
  • evaluation = U
  • indication = Aortic Regurgitation (AR)
  • comment = Routine surveillance (less than one year) of moderate or severe valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Aortic Regurgitation (AR)
  • comment = Routine surveillance (more than one year) of moderate or severe valvular regurgitation without change in clinical status is considered an appropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Aortic Regurgitation (AR)
  • comment = Unable to assess. The appropriateness of routine surveillance of moderate to severe valvular regurgitation is dependent on the time since the last echo.

Mild regurgitation

• Last echo MORE than THREE years ago
  • evaluation = U
  • indication = Aortic Regurgitation (AR)
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo LESS than THREE years
  • evaluation = I
  • indication = Aortic Regurgitation (AR)
  • comment = Routine surveillance (less than 3 years) of mild valvular regurgitation without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Aortic Regurgitation (AR)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular regurgitation is dependent on the time since the last echo.

Acute Coronary Syndrome (ACS)

• Initial Echo test
  • evaluation = A
  • indication = Acute Coronary Syndrome (ACS)
  • comment = Initial evaluation of ventricular function following ACS is considered an appropriate indication.
• To guide therapy
  • evaluation = A
  • indication = Acute Coronary Syndrome (ACS)
  • comment = Re-evaluation of ventricular function following ACS during recovery phase when results will guide therapy is considered an appropriate indication.
• None of the above
  • evaluation = I
  • indication = Acute Coronary Syndrome (ACS)
  • comment = Evaluation of the LV with Echo is only considered appropriate with the initial evaluation and with re-evaluation during the recovery phase when the results will guide therapy.
• Don’t know
  • evaluation = UA
  • indication = Acute Coronary Syndrome (ACS)
  • comment = Unable to assess as the indication of ACS is only considered appropriate with the initial evaluation and for re-evaluation when the results guide therapy.

Device Evaluation

• Ventricular Assist Device
• Other Device- Pacemaker, ICD, CRT, etc.

Other Device- Pacemaker, ICD, CRT, etc.

• Determine candidacy
  • evaluation = A
  • indication = Device Evaluation
  • comment = Initial evaluation, or re-evaluation after re-vascularization and/or optimal medical therapy, to determine candidacy for device therapy (and/or to determine optimal choice of device) are all categorized as appropriate indications.
• Initial evaluation after implant
  • evaluation = U
  • indication = Device Evaluation
  • comment = Initial evaluation for CRT device optimization after implantation is categorized as an 'Uncertain' indication.
• Symptoms possible due to device
  • evaluation = A
  • indication = Device Evaluation
  • comment = Known implanted pacing device with symptoms possibly due to device complication or suboptimal pacing device settings is an appropriate indication.
• Change in clinical status
  • evaluation = A
  • indication = Device Evaluation
  • comment = Routine surveillance of implanted device without a change in clinical status or cardiac exam is categorized as an inappropriate criteria. A change in clinical status is considered an appropriate indication.
• None of the Above
  • evaluation = I
  • indication = Device Evaluation
  • comment = Routine surveillance of an implanted device, without a change in clinical status or cardiac exam, is categorized as an 'Inappropriate' indication.
• Don’t Know
  • evaluation = UA
  • indication = Device Evaluation
  • comment = Unable to determine. Routine surveillance of implanted device without a change in clinical status or cardiac exam is considered an inappropriate indication.

Tricuspid Regurgitation (TR)

• Change in clinical status
  • evaluation = A
  • indication = Tricuspid Regurgitation (TR)
  • comment = Evaluation of tricuspid regurgitation is considered appropriate when there is a clinical change of status.
• Routine echo
• Don't Know
  • evaluation = UA
  • indication = Tricuspid Regurgitation (TR)
  • comment = Unable to assess. A change in clinical status is an appropriate indication for TR but the appropriateness of routine surveillance of TR is dependent on other factors.

Routine echo

• Mild regurgitation
• Moderate or Severe Regurgitation
• Don't Know severity
  • evaluation = UA
  • indication = Tricuspid Regurgitation (TR)
  • comment = Unable to assess, as the appropriateness of an echo for TR without a change in clinical status is dependent on the severity of the Tricuspid Regurgitation.

Moderate or Severe Regurgitation

• Last echo LESS than ONE year ago
  • evaluation = U
  • indication = Tricuspid Regurgitation (TR)
  • comment = Routine surveillance (less than one year) of moderate or severe valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Tricuspid Regurgitation (TR)
  • comment = Routine surveillance (more than one year) of moderate or severe valvular regurgitation without change in clinical status is considered an appropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Tricuspid Regurgitation (TR)
  • comment = Unable to assess. The appropriateness of routine surveillance of moderate to severe valvular regurgitation is dependent on the time since the last echo.

Mild regurgitation

• Last echo MORE than THREE years ago
  • evaluation = U
  • indication = Tricuspid Regurgitation (TR)
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Last echo LESS than THREE years
  • evaluation = I
  • indication = Tricuspid Regurgitation (TR)
  • comment = Routine surveillance (greater than 3 years) of mild valvular regurgitation without a change in clinical status is graded as an Uncertain indication.
• Don't Know
  • evaluation = UA
  • indication = Tricuspid Regurgitation (TR)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular regurgitation is dependent on the time since the last echo.

Mitral Stenosis (MS)

• Change in clinical status
  • evaluation = A
  • indication = Mitral Stenosis (MS)
  • comment = Routine surveillance (greater than 3 years) of mild valvular stenosis without a change in clinical status is considered an appropriate indication.
• Routine Follow up echo
• Don't know
  • evaluation = UA
  • indication = Mitral Stenosis (MS)
  • comment = Unable to assess. A change in clinical status is an appropriate indication for valvular stenosis but the appropriateness of routine surveillance of stenosis is dependent on other factors.

Routine Follow up echo

• Mild stenosis
• Moderate to Severe Stenosis
• Don't Know Severity

Mild stenosis

• Last echo MORE than THREE years ago
  • evaluation = A
  • indication = Mitral Stenosis (MS)
  • comment = Routine surveillance (greater than 3 years) of mild valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than THREE years ago
  • evaluation = I
  • indication = Mitral Stenosis (MS)
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Mitral Stenosis (MS)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of mild valvular stenosis is dependent on the time since the last echo.

Moderate to Severe Stenosis

• Last echo MORE than ONE year ago
  • evaluation = A
  • indication = Mitral Stenosis (MS)
  • comment = Routine surveillance (greater than 1 year) of moderate to severe valvular stenosis without a change in clinical status is considered an appropriate indication.
• Last echo LESS than ONE year ago
  • evaluation = I
  • indication = Mitral Stenosis (MS)
  • comment = Routine surveillance (less than 3 years) of mild valvular stenosis without a change in clinical status is considered an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Mitral Stenosis (MS)
  • comment = Unable to assess, not enough information. The appropriateness of routine surveillance of moderate to severe valvular stenosis is dependent on the time since the last echo.

PACs

• Yes
  • evaluation = A
  • indication = PACs
  • comment = PACs with other evidence of heart disease is an appropriate indication.
• No
  • evaluation = I
  • indication = PACs
  • comment = Infrequent PACs without other evidence of heart disease is categorized as an Inappropriate indication.
• Don’t know
  • evaluation = UA
  • indication = PACs
  • comment = Unable to assess without knowledge of whether there is evidence of heart disease. Infrequent PACs without other evidence of heart disease is categorized as an Inappropriate indication.

PVCs

• Infrequent
• Frequent or Exercised Induced
  • evaluation = A
  • indication = PVCs
  • comment = Frequent PVCs or exercise-induced PVCs are considered an appropriate indication.
• Don’t know
  • evaluation = UA
  • indication = PVCs
  • comment = Not enough information to assess the appropriateness. Although frequent PVCs and exercise-induced PVCs are appropriate, infrequent PVCs without other evidence of heart disease is categorized as an inappropriate indication.

Infrequent

• Yes
  • evaluation = A
  • indication = PVCs
  • comment = Infrequent PVCs in the presence of heart disease is considered an appropriate indication.
• No
  • evaluation = I
  • indication = PVCs
  • comment = Infrequent PVCs without other evidence of heart disease is categorized as an Inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = PVCs
  • comment = Unable to assess as the appropriateness of PVCs as an indication is dependent on whether there is other evidence of heart disease.

• General
• Valvular Disease
• Embolic Event
• Afib/Aflutter
• None of the above
  • evaluation = I
  • indication = General - non specific indication
  • comment = The only appropriate indications for TEE are for valvular disease, embolic events, afib/flutter, suboptimal echo, re-evaluation of interval change, percutaneous guidance and suspected acute aortic disease.

General

• Non Diagnostic Echo (TTE), inadequate visualization of relevant structures
  • evaluation = A
  • indication = Sub optimal Echo
  • comment = Use of TEE when there is a high likelihood of a nondiagnostic TTE due to patient characteristics or inadequate visualization of relevant structures is an appropriate indication.
• Transthoracic Echo (TTE) could NOT resolve all diagnostic and management concerns
  • evaluation = I
  • indication = Routine
  • comment = Routine use of TEE when a diagnostic TTE is reasonably anticipated to resolve all diagnostic and management concerns is categorized as an Inappropriate indication.
• Re-evaluation of prior TEE for interval change
  • evaluation = A
  • indication = Re-evaluation for change
  • comment = Re-evaluation of prior TEE finding for interval change (e.g., resolution of thrombus after anticoagulation, resolution of vegetation after antibiotic therapy) when a change in therapy is anticipated is an appropriate indication.
• Guidance during percutaneous non-coronary cardiac intervention
  • evaluation = A
  • indication = Guidance during percutaneous procedure
  • comment = Guidance during percutaneous noncoronary cardiac interventions including but not limited to closure device placement, radiofrequency ablation, and percutaneous valve procedures are all appropriate indications.
• Suspected acute aortic pathology
  • evaluation = A
  • indication = Suspected acute aortic pathology
  • comment = Suspected acute aortic pathology including but not limited to dissection/transsection is an appropriate indication.
• Pulmonary vein assessment S/P pulmonary vein isolation
• None of the above
  • evaluation = I
  • indication = General
  • comment = The only appropriate indications for TEE under the general category include suboptimal echo, re-evaluation to guide treatment, percutaneous guidance and suspected acute aortic disease.

• Yes, change in therapy anticipated
• No change in therapy anticipated
• Don't know

Pulmonary vein assessment S/P pulmonary vein isolation

• Yes, patient is symptomatic
  • evaluation = A
  • indication = S/P pulmonary vein isolation
  • comment = Routine assessment of pulmonary veins in a symptomatic patient status post pulmonary vein isolation is appropriate; routine assessment is an asymptomatic patient is considered Inappropriate.
• No, patient is asymptomatic
  • evaluation = I
  • indication = S/P pulmonary vein isolation
  • comment = Routine assessment of pulmonary veins in an asymptomatic patient status post pulmonary vein isolation is considered an Inappropriate indication.
• Don't know
  • evaluation = UA
  • indication = S/P pulmonary vein isolation
  • comment = Routine assessment of pulmonary veins in an asymptomatic patient status post pulmonary vein isolation is considered Inappropriate. In order to assess appropriateness knowledge of whether the patient is symptomatic or not is needed.

Valvular Disease

• Assess suitability for an intervention
  • evaluation = A
  • indication = Valvular assessment for suitability of intervention
  • comment = Evaluation of valvular structure and function to assess suitability for, and assist in planning of, an intervention is an appropriate indication.
• Diagnose infective endocartditis
• Transthoracic Echo (TTE) could NOT resolve all diagnostic and management concerns
  • evaluation = A
  • indication = Valvular disease
  • comment = Use of TEE when there is a high likelihood of a nondiagnostic TTE due to patient characteristics or inadequate visualization of relevant structures is an appropriate indication.
• Re-evaluation of prior TEE for interval change
• Guidance during percutaneous valve procedures
  • evaluation = A
  • indication = Guidance during percutaneous valve procedure
  • comment = Guidance during percutaneous valve procedures is an appropriate indication.
• None of the above
  • evaluation = I
  • indication = Valvular disease - non specific indication
  • comment = TEE for valvular disease is only considered an appropriate indication to assess suitability for an intervention, diagnose infective endocarditis, reassess due to suboptimal echo, repeat TEE when a change in therapy is anticipated.
• Don't Know
  • evaluation = UA
  • indication = Valvular disease - non specific indication
  • comment = Unable to assess without more information. TEE for valvular disease is considered appropriate to assess suitability for an intervention, diagnose infective endocarditis, reassess due to suboptimal echo, repeat TEE when a change in therapy is anticipated.

Diagnose infective endocartditis

• Moderate to high pretest probability
  • evaluation = A
  • indication = Infective Endocarditis
  • comment = To diagnose infective endocarditis with a moderate or high pretest probability (e.g., staph bacteremia, fungemia, prosthetic heart valve, or intracardiac device) is an appropriate indication.
• Low pretest probability
  • evaluation = I
  • indication = Infective Endocarditis
  • comment = To diagnose infective endocarditis with a low pretest probability (e.g., transient fever, known alternative source of infection, or negative blood cultures/atypical pathogen for endocarditis) is considered an inappropriate indication.
• Don't Know
  • evaluation = UA
  • indication = Infective Endocarditis
  • comment = Unable to assess without more information as the appropriateness is dependent on the pretest probability of infective endocarditis.

Re-evaluation of prior TEE for interval change

• Yes, change in therapy anticipated
  • evaluation = A
  • indication = Valvular disease
  • comment = Re-evaluation of prior TEE finding for interval change when a change in therapy is anticipated is an appropriate indication.
• No change in therapy anticipated
  • evaluation = I
  • indication = Valvular disease
  • comment = Re-evaluation of prior TEE finding for interval change is an appropriate indication only when a change in therapy is anticipated.
• Don't know
  • evaluation = UA
  • indication = Valvular disease
  • comment = Unable to assess as re-evaluation of prior TEE finding for interval change is only an appropriate indication when a change in therapy is anticipated.

Afib/Aflutter

• Facilitate clinical decision making (anti-coagulation, cardioversion, ablation)
  • evaluation = A
  • indication = Afib/Aflutter
  • comment = Evaluation to facilitate clinical decision making with regard to anticoagulation, cardioversion, and/or radiofrequency ablation is an appropriate indication.
• Decision already made to anticoagulate and not to perform cardioversion
  • evaluation = I
  • indication = Afib/Aflutter
  • comment = Evaluation when a decision has been made to anticoagulate and not to perform cardioversion is considered an inappropriate indication.
• Don't know
  • evaluation = UA
  • indication = Afib/Aflutter
  • comment = Afib/Aflutter is only an appropriate indication if the TEE is used to facilitate the clinical decision making with regards to anticoagulation, cardioversion and/or ablation.

Embolic Event

• No identified non-cardiac source
  • evaluation = A
  • indication = Embolic source
  • comment = Evaluation for cardiovascular source of embolus with no identified noncardiac source is an appropriate indication.
• Previously identified non-cardiac source
  • evaluation = U
  • indication = Embolic source
  • comment = Evaluation for cardiovascular source of embolus with a previously identified noncardiac source is categorized as an uncertain indication.
• Known cardiac source
• Don't know
  • evaluation = UA
  • indication = Embolic source
  • comment = Unable to assess, appropriateness depends on the source of embolus. No identified noncardiac source - Appropriate, previously identified noncardiac source - Uncertain, known cardiac source only appropriate to change patient management.

Known cardiac source

• Yes, TEE would change patient management
  • evaluation = A
  • indication = Embolic source
  • comment = Evaluation for cardiovascular source of embolus with a known cardiac source in which a TEE would change management is appropriate.
• No, TEE would not change patient management
  • evaluation = I
  • indication = Embolic source
  • comment = Evaluation for cardiovascular source of embolus with a known cardiac source in which a TEE would not change management is an inappropriate indication.
• Don't know
  • evaluation = UA
  • indication = Embolic source
  • comment = Unable to assess as appropriateness of evaluation for cardiovascular source of embolus with a known cardiac source is dependent on whether or not the TEE would change patient management.

• Detection of CAD / Risk Assessment
• Ischemic Cardiomyopathy
• Assessment of Viability
• Pre-op Evaluation
• Post Revascularization (PCI or CABG)
• Following Prior Test Results
• ACS (with-in 3 months)
• Doppler Stress Echo
• Other
  • evaluation = I
  • indication = Other
  • comment = The appropriate criteria for a Stress Echo fall under one of the following: Detetion of CAD, Following prior test results, Pre Op, ACS, Post Revascularization, Ischemic Cardiomyopathy and Hemodynamics.

Detection of CAD / Risk Assessment

• Symptomatic
• Asymptomatic
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in the asymptomatic patient is dependent on whether the patient has co-morbidities or is a general population patient.

Symptomatic

• None Acute
• Acute Chest Pain
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in the symptomatic patient is dependent on whether the symptoms are acute or non-acute.

None Acute

• No
  • evaluation = A
  • indication = CAD- Uninterpretable ECG
  • comment = The use of stress echo for the detection of CAD in a symptomatic patient with an uninterpretable ECG is graded as an Appropriate criteria.
• Yes
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in the symptomatic patient is dependent on whether the ECG is interpretable.

Yes

• No
  • evaluation = A
  • indication = CAD-Unable to exercise
  • comment = The use of stress echo for the detection of CAD in a symptomatic patient that is unable to exercise is graded as an Appropriate criteria.
• Yes
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in the symptomatic patient with an interpretable ECG is dependent on the patient's ability to exercise.

Yes

• Low
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in a symptomatic patient with low pretest probability, an interpretable ECG and the patient is able to exercise, is graded as an Inappropriate criteria.
• Intermediate
  • evaluation = A
  • indication = CAD- HIgh pretest probability
  • comment = The use of stress echo for the detection of CAD in a symptomatic patient with intermediate to high pretest probability, an interpretable ECG and the patient is able to exercise, is graded as an Appropriate criteria.
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in the symptomatic patient with an interpretable ECG and able to exercise is dependent on their pretest probability of CAD.

Acute Chest Pain

• Possible ACS
  • evaluation = A
  • indication = CAD-Chest Pain
  • comment = The use of stress echo for the detection of CAD in a patient with acute symptoms and possible ACS is graded as an Appropriate criteria.
• Definite ACS
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in a patient with acute symptoms and definite ACS is graded as an Inappropriate criteria.
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in a patient with acute symptoms is dependent on the patient's ACS status being a possible diagnosis or definite diagnosis.

Asymptomatic

• General Population
• Co-morbidities
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in the asymptomatic patient with is dependent on whether the patient has co-morbidities.

General Population

• No
  • evaluation = U
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an a symptomatic general population patient with an uninterpretable ECG is graded as an Uncertain criteria.
• Yes
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient is dependent on whether the ECG is interpretable.

Yes

• Low - Intermediate
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient of the general population with an interpretable ECG and low - intermediate global CAD risk, is graded as an Inappropriate criteria.
• High
  • evaluation = U
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient of the general population with an interpretable ECG and high global CAD risk, is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient with an interpretable ECG is dependent on their global CAD risk.

Co-morbidities

• New onset of Heart Failure
• Arrhythmias
• Syncope
• Elevated Troponin
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient with co-morbidity is dependent on what the additional disorder is.

New onset of Heart Failure

• Yes
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with new onset of HF is only graded as an Appropriate criteria when there is no prior CAD evaluation and no planned coronary angiography.
• No
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient with new onset of HF is dependent on whether the the patient had a prior CAD evaluation or planned coronary angiography.

No

• Yes
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with new onset of HF is only graded as an Appropriate criteria when there is no prior CAD evaluation and no planned coronary angiography.
• No
  • evaluation = A
  • indication = CAD - Heart failure
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with new onset of HF when there is no prior CAD evaluation and no planned coronary angiography is graded as an Appropriate criteria
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient with new onset of HF is dependent on whether the the patient had a prior CAD evaluation or planned coronary angiography.

Arrhythmias

• VT-Sustained or non-sustained
  • evaluation = A
  • indication = CAD- Arrhythmias
  • comment =
• PVCs- Frequent or Exercised Induced
  • evaluation = A
  • indication = CAD- Arrhythmias
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with new onset of heart failure with frequent PVCs (frequent or exercise induced) is graded as an Appropriate criteria.
• PVCs-Infrequent
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with infrequent PVCs is graded as an Inappropriate criteria
• Afib- New onset
  • evaluation = U
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with new onset of Afib is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient with arrhythmias is dependent on the type of arrhythmia.

Syncope

• Low
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with syncope and low global CAD risk is graded as an Inappropriate criteria
• Intermediate-High
  • evaluation = A
  • indication = CAD- Syncope
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with syncope and intermediate to high global CAD risk is graded as an Appropriate criteria
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient with syncope is dependent on the global CAD risk.

Elevated Troponin

• Yes
  • evaluation = I
  • indication = Detection of CAD / Risk Assessment
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with elevated troponin is only graded as an Appropriate criteria when there are no symptoms or additional evidence of ACS.
• No
  • evaluation = A
  • indication = CAD- Elevated Troponins
  • comment = The use of stress echo for the detection of CAD in an asymptomatic patient with elevated troponin and no symptoms or additional evidence of ACS is graded as an Appropriate criteria
• Don't Know
  • evaluation = UA
  • indication = Detection of CAD / Risk Assessment
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to detect CAD in an asymptomatic patient with elevated troponin is dependent on symptoms or other evidence of ACS.

Following Prior Test Results

• Asymptomatic / Stable
• Symptomatic (New or worsening)
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo after prior testing is dependent on whether the patient is symptomatic or not.

Asymptomatic / Stable

• Prior evidence of subclinical disease (calcium agatston score, carotid intimal medial thickness)
• Prior Stress Imaging Study
• Prior Coronary Angiography
• Treadmill ECG
• None of the above
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The criteria for stress echo after prior testing in an asymptomatic patient relates to the following testing: Treadmill ECG, angiography, stress imaging and calcium Agatston scores.
• Don’t Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo after prior testing is dependent on the results of the prior testing.

Prior evidence of subclinical disease (calcium agatston score, carotid intimal medial thickness)

• Calcium Agatston Score < 100
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with a coronary calcium Agatston score of < 100 is graded as an Inappropriate criteria.
• 100-400
  • evaluation = U
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with a coronary calcium Agatston score of 100-400 is graded as an Uncertain criteria.
• > 400
  • evaluation = A
  • indication = Prior Test Results (Calcium Agatston Score >400)
  • comment = The use of stress echo for asymptomatic patients with a coronary calcium Agatston score of > 400 is graded as an Appropriate criteria.
• Abnormal Intimal Medial Thickness
  • evaluation = U
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with an abnormal carotid intimal medial thickness (> 0.9mm) is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo after prior testing in an asymptomatic patient with prior evidence of subclinical disease is dependent on the test results.

Prior Stress Imaging Study

• Normal
• Equivocal, Borderline, or Discordant
  • evaluation = A
  • indication = Prior Test Results (Equivocal prior imaging test)
  • comment = The use of stress echo for asymptomatic patients with equivocal prior stress imaging studies is graded as an Appropriate criteria.
• Abnormal
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for asymptomatic patients with prior stress imaging study is dependent on the test results.

Normal

• Low Risk
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with normal prior stress imaging studies and low global risk is graded as an Inappropriate criteria.
• Intermediate Risk
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for asymptomatic patients with normal prior stress imaging study is dependent on the patients global risk.

Intermediate Risk

• < 2 years ago
  • evaluation = I
  • indication = Prior Test Results (Calcium Agatston Score >400)
  • comment = The use of stress echo for asymptomatic patients with normal prior stress imaging studies less than 2 years ago and with intermediate global risk is graded as an Inappropriate criteria.
• > 2 years ago
  • evaluation = U
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with normal prior stress imaging studies more than 2 years ago and with intermediate global risk is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for asymptomatic patients with normal prior stress imaging study is dependent on how many years previously the testing was performed.

Abnormal

• < 2 years ago
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with abnormal prior stress imaging studies less than 2 years ago is graded as an Inappropriate criteria.
• > 2 years ago
  • evaluation = U
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with abnormal prior stress imaging studies more than 2 years ago is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for asymptomatic patients with abnormal prior stress imaging study is dependent on how many years previously the testing was performed.

Prior Coronary Angiography

• Normal
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with normal prior coronary angiography is graded as an Inappropriate criteria.
• CAD of Unclear Significance, Equivocal or Borderline
  • evaluation = A
  • indication = Prior Test Results (Equivocal Angiogram)
  • comment = The use of stress echo for asymptomatic patients with equivocal or borderline prior coronary angiography is graded as an Appropriate criteria.
• Abnormal Angiogram
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = The criteria for stress echo after prior coronary angiography in an asymptomatic patient is dependent on the results of the angiography.

Abnormal Angiogram

• < 2 years ago
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with an abnormal prior coronary angiography less than 2 years ago is graded as an Inappropriate criteria.
• > 2 years ago
  • evaluation = U
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with an abnormal prior coronary angiography more than 2 years ago is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo in asymptomatic patients with an abnormal prior coronary angiography is dependent on how long ago the prior testing was performed.

Treadmill ECG

• Low Risk Treadmill Score (Duke,etc.)
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The use of stress echo for asymptomatic patients with a low risk treadmill score is graded as an Inappropriate criteria.
• Intermediate-High Treadmill Score
  • evaluation = A
  • indication = Prior Test Results (High risk treadmill score)
  • comment = The use of stress echo for asymptomatic patients with a intermediate to high risk treadmill score is graded as an Appropriate criteria.
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo after prior treadmill testing is dependent on the results of the treadmill risk score (Duke, etc.)

Symptomatic (New or worsening)

• Coronary Angiogram or Stress Imaging Study Abnormal
  • evaluation = A
  • indication = Prior Test Results (Symptomatic Pt./ Abn. prior test)
  • comment = The use of stress echo for symptomatic patients with an abnormal prior angiogram or stress imaging study is graded as an Appropriate criteria.
• Coronary Angiogram or Stress Imaging Study Normal
  • evaluation = U
  • indication = Following Prior Test Results
  • comment = The use of stress echo for symptomatic patients with a normal prior angiogram or stress imaging study is graded as an Uncertain criteria.
• None of the above
  • evaluation = I
  • indication = Following Prior Test Results
  • comment = The criteria for stress echo after prior testing in a symptomatic patients relates to the following testing: Angiography and stress imaging.
• Don't Know
  • evaluation = UA
  • indication = Following Prior Test Results
  • comment = Not enough information to assess appropriateness as the criteria for stress echo after prior testing is dependent on the results of the prior testing.

Pre-op Evaluation

• Low Risk Surgery
  • evaluation = I
  • indication = Pre-op
  • comment = Perioperative evaluation for risk assessment is graded as an inappropriate indication in the setting of a low risk surgery.
• Intermediate Risk Surgery
• Vascular Surgery
• Don't Know
  • evaluation = UA
  • indication = Pre-op
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for risk assessment prior to surgery is dependent on the kind of surgery.

Intermediate Risk Surgery

• Asymptomatic
• Moderate-Good Functional Capacity (> 4 METs)
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of an Intermediate-Risk Surgery for a patient with good functional capacity, the criteria for stress echo is graded as Inappropriate.
• No Clinical Risk Factors
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of an Intermediate-Risk Surgery for a patient with no clinical risk factors, the criteria for stress echo is graded as Inappropriate.
• >1 Clinical Risk Factor
• Don't Know
  • evaluation = UA
  • indication = Pre-op
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for pre-op for an intermediate risk surgery is dependent on patients symptoms and clinical risk factors.

Asymptomatic

• Yes
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of an Intermediate-Risk Surgery for an asymptomatic patient, the criteria for stress echo is graded as Inappropriate if the patient had a normal catheterization, noninvasive test or previous revascularization within the past year.
• No
  • evaluation = A
  • indication = Pre-op (Intermediate-risk surgery)
  • comment = In the setting of an Intermediate-Risk Surgery for an asymptomatic patient, the criteria for stress echo is graded as Inappropriate if the patient had a normal catheterization, noninvasive test or previous revascularization within the past year.
• Don't Know
  • evaluation = UA
  • indication = Pre-op
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for pre-op for an intermediate risk surgery in an asymptomatic patient is dependent on whether the patient has received previous testing.

>1 Clinical Risk Factor

• Moderate-Good (>4 Mets)
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of an Intermediate-Risk Surgery for a patient with good functional capacity, the criteria for stress echo is graded as Inappropriate.
• Poor or Unknown
  • evaluation = U
  • indication = Pre-op
  • comment = In the setting of an Intermediate-Risk Surgery for a patient with clinical risk factor(s) and poor or unknown functional capacity, the criteria for stress echo is graded as Uncertain.
• Don't Know
  • evaluation = UA
  • indication = Pre-op
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for pre-op for an intermediate risk surgery with clinical risk factors is dependent on the patient's functional capacity.

Vascular Surgery

• Asymptomatic
• Moderate-Good Functional Capacity (> 4 METs)
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of a Vascular Surgery for a patient with good functional capacity, the criteria for stress echo is graded as Inappropriate.
• No Clinical Risk Factors
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of a Vascular Surgery for a patient with no clinical risk factors, the criteria for stress echo is graded as Inappropriate.
• >1 Clinical Risk Factor
• Don't Know
  • evaluation = UA
  • indication = Pre-op
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for pre-op for vascular surgery is dependent on patients symptoms and clinical risk factors.

Asymptomatic

• Yes
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of vascular Surgery for an asymptomatic patient, the criteria for stress echo is graded as Inappropriate if the patient had a normal catheterization, noninvasive test or previous revascularization within the past year.
• No
  • evaluation = A
  • indication = Pre-op
  • comment = In the setting of Vascular Surgery for an asymptomatic patient, the criteria for stress echo is only graded as Inappropriate if the patient had a normal catheterization, noninvasive test or previous revascularization within the past year.
• Don't Know
  • evaluation = UA
  • indication = Pre-op
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for pre-op for vascular surgery in an asymptomatic patient is dependent on whether the patient has received previous testing.

>1 Clinical Risk Factor

• Moderate-Good (>4 Mets)
  • evaluation = I
  • indication = Pre-op
  • comment = In the setting of a Vascular Surgery for a patient with good functional capacity, the criteria for stress echo is graded as Inappropriate.
• Poor or Unknown
  • evaluation = U
  • indication = Pre-op
  • comment = In the setting of a Vascular Surgery for a patient with clinical risk factor(s) and poor or unknown functional capacity, the criteria for stress echo is graded as Uncertain.
• Don't Know
  • evaluation = UA
  • indication = Pre-op
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for pre-op for vascular surgery in a patient with clinical risk factors is dependent on the patient's functional capacity.

ACS (with-in 3 months)

• STEMI
• Unstable Angina ? Non ST STEMI
• Asymptomatic Post Revascularization
  • evaluation = I
  • indication = ACS
  • comment = The use of stress echo for risk assessment post ACS prior to hospital discharge in a patient who has been adequately revascularized is graded as an Inappropriate criteria.
• Prior to Cardiac Rehab
  • evaluation = I
  • indication = ACS
  • comment = The use of stress echo prior to the initiation of cardiac rehabilitation (as a stand-alone indication) is graded as an Inappropriate criteria.
• Don't Know
  • evaluation = UA
  • indication = ACS
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for risk assessment within 3 months of an ACS is dependent on the patients symptoms.

STEMI

• No Recurrent Symptoms / Hemodynamically Stable
• Recurring Symptoms
  • evaluation = A
  • indication = ACS (Recurring symptoms)
  • comment = The use of stress echo for risk assessment post ACS in patients with recurring symptoms is graded as an Appropriate criteria.
• Hemodynamically Unstable
  • evaluation = I
  • indication = ACS
  • comment = The use of stress echo for risk assessment post ACS in patients that are hemodynamically unstable is graded as an Inappropriate criteria.
• Don't Know
  • evaluation = UA
  • indication = ACS
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for the risk assessment of patients post ACS (STEMI) is dependent on whether the patient is symptomatic.

No Recurrent Symptoms / Hemodynamically Stable

• PCI with Revascularization
  • evaluation = I
  • indication = ACS
  • comment = The use of stress echo for risk assessment post ACS in asymptomatic patients with revascularization is graded as an Inappropriate criteria.
• No Angiography
  • evaluation = A
  • indication = ACS (No prior angiography)
  • comment = The use of stress echo for risk assessment post ACS in asymptomatic patients with no prior angiogram is graded as an Appropriate criteria.
• Don't Know
  • evaluation = UA
  • indication = ACS
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for the risk assessment of patients post ACS in asymptomatic patients is dependent on whether angiography was performed.

Unstable Angina ? Non ST STEMI

• Prior Angiography
  • evaluation = I
  • indication = ACS
  • comment = The use of stress echo for risk assessment post ACS (Non ST STEMI) is only graded as an Appropriate criteria if no prior angiography has been performed since the event and the patient is hemodynamically stable with no symptoms.
• No Angiography
  • evaluation = A
  • indication = ACS (No prior angiography)
  • comment = The use of stress echo for risk assessment post ACS (Non ST STEMI) is graded as an Appropriate criteria if no prior angiography has been performed since the event and the patient is hemodynamically stable with no symptoms.
• Don't Know
  • evaluation = UA
  • indication = ACS
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for the risk assessment of patients post ACS (Non ST STEMI) is dependent on whether the patient has had angiography.

Post Revascularization (PCI or CABG)

• Symptomatic
  • evaluation = A
  • indication = Post Revascularization (PCI or CABG). Symptomatic
  • comment = The use of stress echo for risk assessment in symptomatic patients post revascularization is graded as an Appropriate criteria.
• Asymptomatic
• Prior to Cardiac Rehab
  • evaluation = I
  • indication = Post Revascularization (PCI or CABG)
  • comment = The use of stress echo prior to the initiation of cardiac rehabilitation (as a stand-alone indication) is graded as an Inappropriate criteria.
• Don't Know
  • evaluation = UA
  • indication = Post Revascularization (PCI or CABG)
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for risk assessment post revascularization is dependent on the patient's symptoms.

Asymptomatic

• CABG
• PCI
• Incomplete Revascularization
  • evaluation = A
  • indication = Post Revascularization (Incomplete PCI or CABG)
  • comment = The use of stress echo for risk assessment in asymptomatic patients with incomplete revascularization is graded as an Appropriate criteria .
• Don't Know
  • evaluation = UA
  • indication = Post Revascularization (PCI or CABG)
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for risk assessment in asymptomatic patients post revascularization is dependent on the number of years after the revascularization procedure.

CABG

• < 5 years
  • evaluation = I
  • indication = Post Revascularization (PCI or CABG)
  • comment = The use of stress echo for risk assessment in asymptomatic patients less than 5 years post CABG is graded as an Inappropriate criteria .
• > 5 years
  • evaluation = U
  • indication = Post Revascularization (PCI or CABG)
  • comment = The use of stress echo for risk assessment in asymptomatic patients greater than 5 years post CABG is graded as an Uncertain criteria .
• Don't Know
  • evaluation = UA
  • indication = Post Revascularization (PCI or CABG)
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for the risk assessment of patients post CABG, is dependent on the number of years post revascularization.

PCI

• < 2 years
  • evaluation = I
  • indication = Post Revascularization (PCI or CABG)
  • comment = The use of stress echo for risk assessment in asymptomatic patients less than 2 years post PCI is graded as an Inappropriate criteria .
• > 2 years
  • evaluation = U
  • indication = Post Revascularization (PCI or CABG)
  • comment = The use of stress echo for risk assessment in asymptomatic patients greater than 2 years post PCI is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Post Revascularization (PCI or CABG)
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for the risk assessment of patients post PCI, is dependent on the number of years post revascularization.

Ischemic Cardiomyopathy

• Yes
• No
  • evaluation = I
  • indication = Ischemic Cardiomyopathy
  • comment = The use of stress echo for assessment of ischemic cardiomyopathy is only graded as an Appropriate criteria when the patient is eligible for revascularization and has known moderate to severe LV dysfunction.
• Don't Know
  • evaluation = UA
  • indication = Ischemic Cardiomyopathy
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for the assessment of viability with cardiomyopathy is only graded as Appropriate criteria with known moderate to severe LV dysfunction.

Yes

• Yes
  • evaluation = A
  • indication = Cardiomyopathy (LV dysfunction and eligible for revascularization)
  • comment = The use of stress echo for assessment of viability with ischemic cardiomyopathy, when the patient is eligible for revascularization, is graded as an Appropriate criteria.
• No
  • evaluation = I
  • indication = Ischemic Cardiomyopathy
  • comment = The use of stress echo for assessment of viability with ischemic cardiomyopathy, is only graded as an Appropriate criteria, when the patient is eligible for revascularization.
• Don't Know
  • evaluation = UA
  • indication = Ischemic Cardiomyopathy
  • comment = Not enough information to assess appropriateness as the criteria for stress echo, for the assessment of viability with cardiomyopathy, is only graded as Appropriate when the patient is eligible for revascularization.

Assessment of Viability

• Yes
• No
  • evaluation = I
  • indication = Assessment of Viability
  • comment = The use of stress echo for assessment of viability with known moderate to severe LV dysfunction is only graded as an Appropriate criteria when the patient is eligible for revascularization.
• Don't Know
  • evaluation = UA
  • indication = Assessment of Viability
  • comment = Not enough information to assess appropriateness as the criteria for stress echo for the assessment of viability is only graded as Appropriate criteria with known moderate to severe LV dysfunction.

Yes

• Yes
  • evaluation = A
  • indication = Assessment of Viability (LV dysfunction and eligible for revascularization)
  • comment = The use of stress echo for assessment of viability with known moderate to severe LV dysfunction, when the patient is eligible for revascularization, is graded as an Appropriate criteria.
• No
  • evaluation = I
  • indication = Assessment of Viability
  • comment = The use of stress echo for assessment of viability with known moderate to severe LV dysfunction, is only graded as an Appropriate criteria, when the patient is eligible for revascularization.
• Don't Know
  • evaluation = UA
  • indication = Assessment of Viability
  • comment = Not enough information to assess appropriateness as the criteria for stress echo, for the assessment of viability with known moderate to severe LV dysfunction, is only graded as Appropriate when the patient is eligible for revascularization.

Doppler Stress Echo

• Chronic: Asymptomatic
• Chronic: Symptomatic
• Acute Valvular Disease
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Acute moderate or severe mitral or aortic regurgitation is graded as an Inappropriate criteria for Doppler Stress Echo.
• Pulmonary Hypertension
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to assess hemodynamics is dependent on whether the patient is: symptomatic, asymptomatic, has acute disease or pulmonary hypertension.

Chronic: Asymptomatic

• Mitral Stenosis
• Aortic Stenosis
• Mitral Regurgitation
• Aortic Regurgitation
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to assess hemodynamics is dependent on the type and severity of valvular disease.

Mitral Stenosis

• Mild
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic mild mitral stenosis is graded as an Inappropriate criteria for Doppler Stress Echo in asymptomatic patients.
• Moderate
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic moderate mitral stenosis is graded as an Uncertain criteria for Doppler Stress Echo in asymptomatic patients.
• Severe
  • evaluation = A
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic severe mitral stenosis is graded as an Appropriate criteria for Doppler Stress Echo in asymptomatic patients.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness, as the criteria for Doppler stress echo for the hemodynamic assessment of mitral stenosis is dependent on the severity.

Aortic Stenosis

• Mild
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic mild aortic stenosis is graded as an Inappropriate criteria for Doppler Stress Echo in asymptomatic patients.
• Moderate
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic moderate aortic stenosis is graded as an Uncertain criteria for Doppler Stress Echo in asymptomatic patients.
• Severe
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic severe aortic stenosis is graded as an Uncertain criteria for Doppler Stress Echo in asymptomatic patients.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness, as the criteria for Doppler stress echo for the hemodynamic assessment of aortic stenosis is dependent on the severity.

Mitral Regurgitation

• Mild
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic mild mitral regurgitation is graded as an Inappropriate criteria for Doppler Stress Echo in asymptomatic patients.
• Moderate
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic moderate mitral regurgitation is graded as an Uncertain criteria for Doppler Stress Echo in asymptomatic patients.
• Severe
  • evaluation = A
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic severe mitral regurgitation is graded as an Appropriate criteria for Doppler Stress Echo in asymptomatic patients.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness, as the criteria for Doppler stress echo for the hemodynamic assessment of mitral regurgitation is dependent on the severity.

Aortic Regurgitation

• Mild
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic mild aortic regurgitation is graded as an Inappropriate criteria for Doppler Stress Echo in asymptomatic patients.
• Moderate
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic moderate aortic regurgitation is graded as an Uncertain criteria for Doppler Stress Echo in asymptomatic patients.
• Severe
  • evaluation = A
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic severe aortic regurgitation is graded as an Appropriate criteria for Doppler Stress Echo in asymptomatic patients.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness, as the criteria for Doppler stress echo for the hemodynamic assessment of aortic regurgitation is dependent on the severity.

Chronic: Symptomatic

• Mitral Stenosis
• Aortic Stenosis
• Mitral Regurgitation
• None of the Above
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = In the presence of symptoms in a patient with chronic valvular disease only the criteria of MS, AS and MR are graded for appropriateness.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to assess hemodynamics is dependent on the type and severity of valvular disease.

Mitral Stenosis

• Mild
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic mild mitral stenosis is graded as an Uncertain criteria for Doppler Stress Echo in symptomatic patients.
• Moderate
  • evaluation = A
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic moderate mitral stenosis is graded as an Appropriate criteria for Doppler Stress Echo in symptomatic patients.
• Severe
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic severe mitral stenosis is graded as an Inappropriate criteria for Doppler Stress Echo in symptomatic patients.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness, as the criteria for Doppler stress echo for the hemodynamic assessment of mitral stenosis is dependent on the severity.

Aortic Stenosis

• Equivocal (low gradient due to low cardiac output)
  • evaluation = A
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for equivocal aortic stenosis is graded as an Appropriate criteria for Doppler Stress Echo (Dobutamine Only) in symptomatic patients.
• Severe
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic severe aortic stenosis is graded as an Inappropriate criteria for Doppler Stress Echo in symptomatic patients.
• None of the Above
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for aortic stenosis in a symptomatic patient is only graded as an Appropriate criteria for Doppler Stress Echo when the severity AS is equivocal or severe.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness, as the criteria for Doppler stress echo for the hemodynamic assessment of aortic stenosis is dependent on the severity.

Mitral Regurgitation

• Mild
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic mild mitral regurgitation is graded as an Uncertain criteria for Doppler Stress Echo in symptomatic patients.
• Moderate
  • evaluation = A
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic moderate mitral regurgitation is graded as an Appropriate criteria for Doppler Stress Echo in symptomatic patients.
• Severe and/or Severe LV enlargement or dysfunction
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Assessment of hemodynamics for chronic severe mitral regurgitation or regurgitation with severe LV enlargement or LV dysfunction is graded as an Inappropriate criteria for Doppler Stress Echo in symptomatic patients.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness, as the criteria for Doppler stress echo for the hemodynamic assessment of mitral regurgitation is dependent on the severity.

Pulmonary Hypertension

• Suspected Pulmonary Hypertension
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Suspected pulmonary artery hypertension with normal or borderline elevated estimated right ventricular systolic pressure on resting echocardiographic study is graded as an Uncertain criteria.
• Known Resting Pulmonary Hypertension (Routine Eval)
  • evaluation = I
  • indication = Doppler Stress Echo
  • comment = Routine evaluation of patients with known resting pulmonary hypertension is graded as an Inappropriate criteria.
• Exercised Induced Pulmonary Hypertension (Eval to assess therapy)
  • evaluation = U
  • indication = Doppler Stress Echo
  • comment = Re-evaluation of patient with exercise-induced pulmonary hypertension to evaluate response to therapy is graded as an Uncertain criteria.
• Don't Know
  • evaluation = UA
  • indication = Doppler Stress Echo
  • comment = Not enough information to assess appropriateness as the criteria for stress echo to assess hemodynamics for pulmonary hypertension is dependent on type and severity of pulmonary hypertension.

• Great Study
• Acceptable Study
• Use if no other options
• Do not submit

• Great Study
• Acceptable Study
• Use if no other options
• Do not submit

• Great Study
• Acceptable Study
• Use if no other options
• Do not submit

• Chamber Size
• REST LVF
• STRESS LVF
• Mass / Thrombus / Tumor etc.
• Septa
• Valvular Heart Disease
• Other

• Chamber Size
• REST LVF
• STRESS LVF
• Mass / Thrombus / Tumor etc.
• Septa
• Valvular Heart Disease
• Other

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