Atrial fibrillation
Multifocal Atrial Tachycardia (MAT)
Frequent Atrial Premature Contractions
More than 50 premature ventricular contractions per
Inability to lie flat
Body mass index >40
Calcium (Agatston) score of 1000 or more
Inability to hold breath for >8 seconds
Renal insufficiency (serum creatinine>1.5 mg/dL)
1.1.1 No prior Calcium Scoring for 5 years
1.1.2 No prior abnormal stress tests, coronary CTs, or catheterizations
1.2.1 No prior Calcium Scoring for 5 years
1.2.2 No prior abnormal stress tests, coronary CTs, or catheterizations
1.2.3. Results of coronary calcium scoring would influence the prescription of statin therapy6
2.1. Evaluation of pulmonary vein anatomy prior to invasive radiofrequency ablation for atrial fibrillation
2.2. Non-invasive coronary vein mapping prior to placement of biventricular pacemaker
2.3. Non-invasive coronary arterial mapping, including internal mammary artery prior to repeat cardiac surgical revascularization
2.4. Evaluation of native or prosthetic valve, cardiac mass, or pericardial mass when a prior CT, cardiac MRI, or echocardiogram was performed for this indication and was non-diagnostic
2.5. Evaluation of left and/or right ventricular function when a prior echocardiogram, MRI, or MUGA was performed for this indication and was non-diagnostic
2.6. Characterization of aortic valve morphology (i.e. trileaflet or bicuspid) when not able to determine by echocardiography7
2.7. Arrhythmogenic right ventricular dysplasia/cardiomyopathy is suspected8 [BOTH]
Based on any one of the following: echocardiographic evidence of regional RV akinesia, dyskinesia, or aneurysm; repolarization abnormalities on electrocardiogram (e.g. inverted T waves in right precordial leads in individuals>14 years of age in the absence of complete right bundle branch block); depolarization abnormalities on electrocardiogram (e.g. epsilon waves in right precordial leads); arrhythmia (e.g. non-sustained or sustained ventricular tachycardia of left bundle branch block morphology or >500 ventricular extrasystoles/24 hours on Holter monitoring); or family history
No cardiac MRI has been performed because there is a contraindication to MRI OR a cardiac MRI was performed but was non-diagnostic
3.1.1. Evaluation of thoracic arteriovenous anomaly (CTA or MRA preferred)
3.1.2.1. No cardiac CT or cardiac MRI has been performed and there is contraindication to MRI
3.1.2.2. A cardiac CT or cardiac MRI was performed one year ago or more
4.1.1 No stress or angiographic studies in prior 60 days
4.1.2 Evaluation of coronary arteries in patients with new onset heart failure to assess etiology
4.2.2 No ECG changes
4.2.3 Serial enzymes negative
4.3.1 Low to Intermediate pretest probability of CAD See Chart Below
4.3.2 ECG uninterpretable or unable to exercise (for stress test)Abnormal or equivocal stress test (e.g. discordance between EKG changes and perfusion defects or inducible wall motion abnormalities)
4.3.3 No chest pain
4.3.4 Catheterization not planned
4.4.1 New chest pain or shortness of breath with prior coronary artery bypass grafting/assessment of graft patency
4.4.2 No symptoms [One of the following]:Left main coronary artery stent is present 1Stent diameter>3 mm and ≥2 years since PCI Coronary artery bypass grafting surgery≥5 years
4.5 Incomplete prior coronary angiogram
4.6 In place of coronary angiogram in cases with difficult vascular access or at risk due to anticoagulation
4.7 Evaluation of suspected coronary aretery anomaly
4.8 Prior to noncoronary cardiac or other high risk surgery
4.9 Detection of left atrial appendage thrombus in patients with atrial fibrillation when transesophageal echocardiography is not planned or is contraindicated
4.10.1 Mark, Daniel B., Berman, Daniel S., Budoff, Matthew J., Carr, J. Jeffrey, Gerber, Thomas C., Hecht, Harvey S., Hlatky, Mark A., Hodgson, John McB., Lauer, Michael S., Miller, Julie M., Morin, Richard L., Mukherjee, Debabrata, Poon, Michael, Rubin, Geoffrey D., Schwartz, Robert S.
ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
J Am Coll Cardiol 2010 55: 2663-2699
4.10.2 Thompson Randall C, Thomas Gregory S, “Coronary Angiography by Computed Tomography” (Update). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison’s Principles of Internal Medicine, 17e: http://www.accessmedicine.com/updatesContent.aspx?aid=1000672.
4.10.3 Thompson RC et al: Potential indications of coronary angiography by computed tomography (CT). Am Heart Hosp J 3:161, 2005b
Hendel RC, Patel MR, Kramer CM, et al . ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006;48:1475-1497 Schroeder S, Achenbach S, Bengel F, et al . Cardiac computed tomography: indications, applications, limitations, and training requirements-report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J 2008;29:531-556.
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