October 16, 2017 — The American College of Cardiology (ACC), along with several partnering societies, recently released appropriate use criteria addressing the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease.
Initial diagnosis and subsequent follow-up for valvular heart disease frequently rely on imaging with more than one imaging modality. Rapidly evolving less-invasive and transcatheter treatment options have fueled the need for precise preprocedural and intraprocedural anatomic and functional imaging.
“As imaging technologies and clinical applications continue to advance, the healthcare community must understand how best to incorporate these technologies into daily clinical care and how to choose between new and established imaging technologies,” said John U. Doherty, M.D., professor of medicine at Thomas Jefferson University and chair of the writing committee.
This document addresses the appropriate use of multiple cardiac imaging modalities available to clinicians in the evaluation of patients with valvular heart disease. It covers the spectrum of patients with valvular heart disease — from patients with no symptoms who are suspected of having valvular heart disease, to patients with signs and symptoms ranging from mild to severe. A standardized approach was used to create different categories of indications with the goal of capturing actual real-world clinical scenarios. These clinical scenarios, or indications, were developed by the writing committee to cover established and emerging treatment approaches for valvular heart disease. An independent rating panel scored the clinical scenarios, assessing whether the use of an imaging test for each indication fell into one of the following categories: Appropriate, May Be Appropriate or Rarely Appropriate.
The goal of this document is to identify all imaging tests that are considered reasonable for a given clinical indication. Therefore, the testing modalities were rated for their level of appropriateness specific to clinical scenarios rather than a forced rank order comparison against other testing modalities.
According to the writing committee, the indications are, at times, intended to be broad to cover an array of cardiovascular signs and symptoms and to account for the ordering physician’s best judgment regarding the presence of cardiovascular abnormalities. However, there are likely clinical scenarios that are not covered in the document.
The ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease is published online in the Journal of the American College of Cardiology, the Journal of the American Society of Echocardiography, the Journal of Nuclear Cardiology and the Journal of Thoracic and Cardiovascular Surgery. This document is the first of two companion appropriate use criteria documents developed by these partnering societies. The second companion document, addressing multimodality imaging in structural heart disease, will publish at a later date.
For more information: www.acc.org