To determine if revascularization is feasible, looking for “hibernating myocardium”
Gavin I.W. Galasko and Avijit Lahiri The non-invasive assessment of hibernating myocardium in ischaemic cardiomyopathy—a myriad of techniques Eur J Heart Fail (2003) 5(3): 217-227
Prior to revacsularization to evaluate myocardial viablility
Recent SPECT myocardial perfusion scan or other study nondiagnostic
Obese (BMI > 40)
Breast implants
Large breasts
Prior surgery to chest wall that might interfere with SPECT
Changed chest pain CHF – annual exam Stable or asymptomatic – allowed every two years
Abnormal stress test Diabetes
There is an online Framingham Risk Calculator at http://www.intmed.mcw.edu/clincalc/heartrisk.html
Patient on Digoxin or similar medication
Patient unable to perform stress test
Uninterpretable EKG
Ventricular tachycardia
Chest pain syndrome includes ANY OF THE FOLLOWING pain, tightness,or burning sensation in chest, dyspnea, shoulder pain, and jaw pain.
Low pretest probability of CAD AND ECG uninterpretable OR unable to exercise
ECG interpretable AND able to exercise ECG uninterpretable OR unable to exercise
Regardless of ECG interpretability and ability to exercise
Low-risk TIMI score AND Peak troponin: borderline, equivocal, minimally elevated
Low-risk TIMI score AND Negative peak troponin levels
High-risk TIMI score AND Peak troponin: borderline, equivocal, minimally elevated
High-risk TIMI score AND Negative peak troponin levels
Recent or current chest pin AND Initial troponin negative
Arrhythmia
Diabetes
Framingham risk percentage is >10%
History of CHF
History of CVA
Mitral or other valvular disease
Ventricular Tachycardia
Intermediate or high CHD risk (ATP III risk criteria)
Elevated Troponin Troponin elevation without additional evidence of acute coronary syndrome
Coronary Calcium Agatston Score greater than 100, or
Equivocal, Borderline, or Discordant testing, or
Duke Treadmill Score High or Intermediate
Equivocal, Borderline, or Discordant Noninvasive stress testing AND CAD remains a concern
Abnormal coronary angiography and New or Worsening Symptoms
Abnormal prior stress imaging study and New or Worsening Symptoms
Coronary Angiography (Invasive or Noninvasive) Results showing Coronary stenosis or anatomic abnormality of uncertain significance
Asymptomatic
High CHD risk
Duke Treadmill Score High or Intermediate
Greater than or equal to 1 clinical risk factor OR
Poor or unknown functional capacity (less than 4 METS)
Greater than or equal to 1 clinical risk factor OR
Poor or unknown functional capacity (less than 4 METS)
Hemodynamically stable, no recurrent chest pain symptoms or no signs of HF
To evaluate for inducible ischemia
No prior coronary angiography
Evaluation of ischemic equivalent
Incomplete revascularization
Additional revascularization feasible
Greater than or equal to 5 years after CABG A (7)
Known severe LV dysfunction
Patient eligible for revascularization
Assessment of LV function with radionuclide angiography (ERNA or FP RNA)
No recent reliable diagnostic information regarding ventricular function obtained with another imaging modality
Routine‡ use of rest/stress ECG-gating with SPECT or PET MPI A (9)
Evaluation of Ventricular Function during Use of Potentially Cardiotoxic Therapy (e.g., Doxorubicin)
Serial assessment of LV function with radionuclide angiogram (ERNA or FP RNA)
American College of Cardiology Foundation Appropriate Use Criteria Task Force, , American Society of Nuclear Cardiology, , American College of Radiology, , American Heart Association, , American Society of Echocardiography, , Society of Cardiovascular Computed Tomography, , Society for Cardiovascular Magnetic Resonance, , Society of Nuclear Medicine, , American College of Emergency Physicians, , Hendel, Robert C., Berman, Daniel S., Di Carli, Marcelo F., Heidenreich, Paul A., Henkin, Robert E., Pellikka, Patricia A., Pohost, Gerald M., Williams, Kim A. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging
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