The following are key points to remember from the multisociety document on 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease:

1. This document addresses the evaluation and use of multimodality imaging in the diagnosis and management of structural (nonvalvular) heart disease.
2. The goal of this document is the determination of the range of modalities that may or may not be reasonable for specific indications rather than determination of a single best test for each indication or a rank order.
3. In the scenario, if more than one modality falls into the same Appropriate Use category, physician judgment and available local expertise should be used to determine choice of test.
4. Transthoracic echocardiography (TTE) is considered “appropriate” for the initial cardiac evaluation of a known systemic, congenital, or acquired disease that could be associated with structural heart disease.
5. TTE, cardiac magnetic resonance imaging (MRI), or radionuclide ventriculography is considered appropriate evaluation after appropriate time interval following revascularization and/or optimal medical therapy to determine candidacy for implantable cardioverter-defibrillator/cardiac resynchronization therapy and/or to determine optimal choice of device.
6. TTE, transesophageal echocardiography (TEE), cardiac MRI, or cardiac computed tomography (CT) is considered “appropriate” for initial evaluation of cardiac mass, suspected tumor or thrombus, or potential cardiac source of emboli.
7. TEE, cardiac MRI, or cardiac CT is considered “appropriate” for comprehensive further evaluation of dilated aortic sinuses or ascending aorta identified by TTE.
8. TEE or intracardiac echocardiography (ICE) and fluoroscopy are considered “appropriate” for intraprocedural guidance for closure of patent foramen ovale or atrial septal defect.
9. TEE and fluoroscopy are considered “appropriate” for intraprocedural guidance for left atrial appendage occlusion. ICE “may be appropriate” in this situation.
10. The writing committee states that the modalities are not to be considered in a rank order and may be used relative to individual patient circumstances and the balance of risk versus benefit. Accordingly, a study rated “may be appropriate” should not be denied reimbursement in lieu of one rated “appropriate.” In some circumstances, a study ranked “rarely appropriate” may be clinically useful if rationale is properly documented.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Transplant, Pulmonary Hypertension, Interventions and ACS, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Angiography, Computed Tomography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging, Hypertension

Keywords: Acute Coronary Syndrome, Angiography, Arrhythmias, Cardiac, Cardiac Imaging Techniques, Cardiac Imaging Techniques, Cardiomyopathies, Cardiac Resynchronization Therapy, Defibrillators, Implantable, Echocardiography, Echocardiography, Transesophageal, Magnetic Resonance Imaging, Fluoroscopy, Multidetector Computed Tomography, Heart Failure, Heart Septal Defects, Atrial, Heart Transplantation, Heart Valve Diseases, Hypertension, Hypotension, Diagnostic Imaging, Cardiac Imaging Techniques, Pacemaker, Artificial, Myocardial Perfusion Imaging, Septal Occluder Device, Foramen Ovale, Patent, Positron-Emission Tomography, Hypertension, Pulmonary, Radionuclide Imaging, Risk Factors, Exercise Test, Stroke, Syncope, Ischemic Attack, Transient, Ultrasonography, Secondary Prevention

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