ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons - 04/04/18

Doi : 10.1016/j.echo.2017.08.012

John U. Doherty, MD, FACC, FAHA ^{^{∗
American College of Cardiology Representative.}} : Chair, Writing Group, Smadar Kort, MD, FACC, FASE, FAHA ^{^{†
American Society of Echocardiography Representative.}} : Writing Group Member, Roxana Mehran, MD, FACC, MSCAI, FAHA ^{^{‡
Society for Cardiovascular Angiography and Interventions Representative.}} : Writing Group Member, Paul Schoenhagen, MD, FAHA ^{^{§
Society of Cardiovascular Computed Tomography Representative.}} : Writing Group Member, Prem Soman, MD, PhD, FACC ^{^{‖
American Society of Nuclear Cardiology Representative.}} : Writing Group Member, Greg J. Dehmer, MD, MACC, MSCAI, FACP, FAHA ^{^{∗
American College of Cardiology Representative.}} : Moderator, Rating Panel, John U. Doherty, MD, FACC, FAHA ^{^{∗
American College of Cardiology Representative.}} : Writing Group Liaison, Rating Panel Member, Paul Schoenhagen, MD, FAHA ^{^{§
Society of Cardiovascular Computed Tomography Representative.}} : Writing Group Liaison, Rating Panel Member, Zahid Amin, MD, FSCAI, FAHA ^{^{‡
Society for Cardiovascular Angiography and Interventions Representative.}} : Rating Panel Member, Thomas M. Bashore, MD, FACC ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, Andrew Boyle, MD ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, Dennis A. Calnon, MD, FACC, FASE, MASNC, FSCCT ^{^{‖
American Society of Nuclear Cardiology Representative.}} : Rating Panel Member, Blase Carabello, MD, FACC ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, Manuel D. Cerqueira, MD, FACC, MASNC ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, John Conte, MD ^{^{¶
Society of Thoracic Surgeons Representative.}} : Rating Panel Member, Milind Desai, MD, FACC ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, Daniel Edmundowicz, MD, FACC ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, Victor A. Ferrari, MD, FACC ^{^{#
Society for Cardiovascular Magnetic Resonance Representative.}} : Rating Panel Member, Brian Ghoshhajra, MD, MBA ^{^{§
Society of Cardiovascular Computed Tomography Representative.}} : Rating Panel Member, Praveen Mehrotra, MD, FACC ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, Saman Nazarian, MD, PhD ^{^{∗∗
Heart Rhythm Society Representative.}} : Rating Panel Member, T. Brett Reece, MD ^{^{††
American Association for Thoracic Surgery Representative.}} : Rating Panel Member, Balaji Tamarappoo, MD, PhD ^{^{∗
American College of Cardiology Representative.}} : Rating Panel Member, Wendy S. Tzou, MD, FACC, FHRS ^{^{‡‡
American Heart Association Representative.}} : Rating Panel Member, John B. Wong, MD : Rating Panel Member, John U. Doherty, MD, FACC, FACP, FAHA : Co-Chair, Appropriate Use Criteria Task Force, Gregory J. Dehmer, MD, MACC, MSCAI, FACP, FAHA : Co-Chair, Appropriate Use Criteria Task Force, Steven R. Bailey, MD, FACC, MSCAI, FAHA : Appropriate Use Criteria Task Force Member, Nicole M. Bhave, MD, FACC : Appropriate Use Criteria Task Force Member, Alan S. Brown, MD, FACC ^{^{§§
Former Task Force member; current member during writing effort.}} : Appropriate Use Criteria Task Force Member, Stacie L. Daugherty, MD, FACC : Appropriate Use Criteria Task Force Member, Larry S. Dean, MD, FACC, MSCAI : Appropriate Use Criteria Task Force Member, Milind Y. Desai, MBBS, FACC : Appropriate Use Criteria Task Force Member, Claire S. Duvernoy, MD, FACC ^{^{§§
Former Task Force member; current member during writing effort.}} : Appropriate Use Criteria Task Force Member, Linda D. Gillam, MD, FACC : Appropriate Use Criteria Task Force Member, Robert C. Hendel, MD, FACC, FAHA ^{^{§§
Former Task Force member; current member during writing effort.}} : Appropriate Use Criteria Task Force Member, Christopher M. Kramer, MD, FACC, FAHA ^{^{‖‖
Former Task Force co-chair; current co-chair during writing effort.}} : Appropriate Use Criteria Task Force Member, Bruce D. Lindsay, MD, FACC ^{^{§§
Former Task Force member; current member during writing effort.}} : Appropriate Use Criteria Task Force Member, Warren J. Manning, MD, FACC : Appropriate Use Criteria Task Force Member, Praveen Mehrotra, MD, FACC, FASE : Appropriate Use Criteria Task Force Member, Manesh R. Patel, MD, FACC, FSCAI, FAHA ^{^{¶¶
Former Task Force chair; current chair during writing effort.}} : Appropriate Use Criteria Task Force Member, Ritu Sachdeva, MBBS, FACC : Appropriate Use Criteria Task Force Member, L. Samuel Wann, MD, MACC ^{^{§§
Former Task Force member; current member during writing effort.}} : Appropriate Use Criteria Task Force Member, David E. Winchester, MD, FACC : Appropriate Use Criteria Task Force Member, Michael J. Wolk, MD, MACC ^{^{§§
Former Task Force member; current member during writing effort.}} : Appropriate Use Criteria Task Force Member, Joseph M. Allen, MA ^{^{§§
Former Task Force member; current member during writing effort.}} : Appropriate Use Criteria Task Force Member

Abstract

This document is 1 of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. This document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas the second, companion document addresses this topic with regard to structural heart disease. Although there is clinical overlap, the documents addressing valvular and structural heart disease are published separately, albeit with a common structure. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of valvular and structural heart disease, encompassing multiple imaging modalities.

Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association guidelines.

A separate, independent rating panel scored the 92 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario.

The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations where diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.

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Key Words : ACC Appropriate Use Criteria, imaging, multimodality, valvular heart disease

Abbreviations : AS, AUC, CCT, LV, MR, TAVR, TEE, TTE, VHD

Plan

Preface

Introduction

Methods

Indication Development

General Assumptions

Definitions

Multimodality Imaging in VHD: Appropriate Use Criteria (By Indication)

Initial Evaluation for VHD

Prior Testing

Transcatheter Intervention for VHD

Discussion

Conclusions

ACC President and Staff

	This document was approved by the American College of Cardiology Clinical Policy Approval Committee in June 2017.
	The American College of Cardiology requests that this document be cited as follows: Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for multimodality imaging in valvular heart disease: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.
	This document has been reprinted in the Journal of the American Society of Echocardiography, Journal of Nuclear Cardiology, and the Journal of Thoracic and Cardiovascular Surgery.
	This document is reprinted with the permission of the American College of Cardiology Foundation.
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