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ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography

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ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography © 2003 by the American College of Cardiology Foundation and the American Heart Association, Inc. ACC/AHA PRACTICE GUIDELINES—FULL TEXT ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography) COMMITTEE MEMBERS Melvin D. Cheitlin, MD, MACC, Chair William F. Armstrong, MD, FACC, FAHA Linda D. Gillam, MD, FACC, FAHA Gerard P. Aurigemma, MD, FACC, FAHA Thomas R. Kimball, MD, FACC George A. Beller, MD, FACC, FAHA William G. Kussmaul, MD, FACC Fredrick Z. Bierman, MD, FACC Alan S. Pearlman, MD, FACC, FAHA, FASE Jack L. Davis, MD, FACC John T. Philbrick, MD, FACP Pamela S. Douglas, MD, FACC, FAHA, FASE Harry Rakowski, MD, FACC, FASE David P. Faxon, MD, FACC, FAHA Daniel M. Thys, MD, FACC, FAHA TASK FORCE MEMBERS Elliott M. Antman, MD, FACC, FAHA, Chair Sidney C. Smith, Jr., MD, FACC, FAHA, Vice Chair Joseph S. Alpert, MD, FACC, FAHA Gabriel Gregoratos, MD, FACC, FAHA Jeffrey L. Anderson, MD, FACC Loren F. Hiratzka, MD, FACC, FAHA David P. Faxon, MD, FACC, FAHA Sharon Ann Hunt, MD, FACC, FAHA Valentin Fuster, MD, PhD, FACC, FAHA Alice K. Jacobs, MD, FACC, FAHA Raymond J. Gibbons, MD, FACC, FAHA*† Richard O. Russell, MD, FACC, FAHA* *Former Task Force Member ify version and reprint number): Up to 999 copies, call 1-800-611-6083 (US †Immediate Past Task Force Chair only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214- 691-6342, or e-mail [email protected]. This document was approved by the American College of Cardiology Foundation Board of Trustees in May 2003, by the American Heart Association Science Advisory and Coordinating Committee in May 2003, and by the TABLE OF CONTENTS American Society of Echocardiography Board of Directors in May 2003. When citing this document, the American College of Cardiology, American Preamble ...................................................................................3 Heart Association, and American Society of Echocardiography request that the following citation format be used: Cheitlin MD, Armstrong WF, Aurigemma I. Introduction, General Considerations, and Scope.............3 GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, A. Hierarchical Levels of Echocardiography Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys Assessment....................................................................4 DM. ACC/AHA/ASE 2003 guideline update for the clinical application of II. Murmurs and Valvular Heart Disease...............................7 echocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE A. Murmurs........................................................................7 Committee to Update the 1997 Guidelines for the Clinical Application of B. Native Valvular Stenosis...............................................8 Echocardiography). 2003. American College of Cardiology Web Site. Available C. Native Valvular Regurgitation.......................................9 at: www.acc.org/clinical/guidelines/echo/index.pdf. D. Repeated Studies in Valvular Heart Disease.................9 This document is available on the World Wide Web sites of the American E. Mitral Valve Prolapse..................................................10 College of Cardiology (www.acc.org), the American Heart Association F. Infective Endocarditis: Native Valves..........................11 (www.americanheart.org), and the American Society of Echocardiography G. Prosthetic Valves.........................................................11 (www.asecho.org). Single copies of this document are available by calling 1- H. Prosthetic Valve Dysfunction and Endocarditis..........14 800-253-4636 or writing the American College of Cardiology Foundation, Resource Center, at 9111 Old Georgetown Road, Bethesda, MD 20814-1699. III. Chest Pain........................................................................ 14 Ask for reprint number 71-0264. To obtain a reprint of the Summary Article published in the September 3, 2003 issue of the Journal of the American IV. Ischemic Heart Disease....................................................15 College of Cardiology, the September 2, 2003 issue of Circulation, and the A. Acute Ischemic Syndromes (Acute Myocardial October 2003 issue of the Journal of the American Society of Echo- Infarction and Unstable Angina)..................................15 cardiography, ask for reprint number 71-0263. To purchase bulk reprints (spec- 1. Diagnosis.................................................................15 ACC - www.acc.org Cheitlin et al. 2003 AHA - www.americanheart.org 2 ACC/AHA Practice Guidelines ASE - www.asecho.org 2. Severity of Disease/Risk Assessment/Prognosis.....16 VIII. Diseases of the Great Vessels.........................................40 3. Assessment of Complications.................................17 A. Aortic Aneurysm.......................................................40 a. Acute Mitral Regurgitation..................................17 B. Aortic Dissection.......................................................40 b. Infarct Expansion and LV Remodeling...............17 C. Aortic Intramural Hematoma....................................40 c. Ventricular Septal Rupture.................................. 17 D. Aortic Rupture and Thoracic Aortic Degenerative d. Free Wall Rupture............................................... 17 Disease....................................................................... 41 e. Intracardiac Thrombus.........................................17 E. The Great Veins.........................................................41 f. RV Infarction....................................................... 17 IX. Pulmonary and Pulmonary Vascular Disease................41 g. Pericardial Effusion.............................................17 A. Pulmonary Thromboembolism................................. 42 4. Assessment of Therapy............................................17 5. Predischarge Evaluation Using Stress X. Systemic Hypertension..................................................42 Echocardiography....................................................19 XI. Neurological Disease and Other Cardioembolic B. Chronic Ischemic Heart Disease................................ 22 Disease...........................................................................43 1. Diagnostic Accuracy of Echocardiographic Techniques in Chronic CAD...................................22 XII. Arrhythmias and Palpitation..........................................46 a. TTE (at Rest).......................................................22 A. Cardioversion of Patients With Atrial Fibrillation... 47 b. Stress Echocardiography..................................... 22 B. Syncope.....................................................................49 2. Special Issues With Regard to Stress XIIa. Screening....................................................................... 50 Echocardiography for the Diagnosis of CAD.........27 a. The Influence of Bayes’ Theorem.......................27 XIII. Echocardiography in the Critically Ill........................... 51 b. Influence of Posttest Referral Bias..................... 27 A. Echocardiography in the Trauma Patient..................53 c. Pharmacological Stress Echocardiography......... 27 XIV. Two-Dimensional Echocardiography in the Adult d. Stress Echocardiography for Diagnosis of Patient With Congenital Heart Disease......................... 57 CAD in Women................................................... 29 e. Stress Echocardiography for Diagnosis of XV. Echocardiography in the Pediatric Patient.................... 60 CAD in Patients After Cardiac A. Resource Utilization and Age...................................60 Transplantation.................................................... 29 B. Cardiovascular Disease in the Neonate.....................61 f. Detection of CAD in Asymptomatic Patients......29 1. Structural Congenital Cardiovascular Disease...... 61 g. Stress Echocardiography for Preoperative C. Cardiopulmonary Disease.........................................61 Evaluation............................................................29 D. Arrhythmias/Conduction Disturbances.................... 62 3. Diagnosis of Myocardial Viability in Chronic E. Acquired Cardiovascular Disease in the Neonate.....62 CAD........................................................................29 F. Congenital Cardiovascular Disease in the Infant, 4. Assessment of Disease Severity/Risk Stratification/ Child, and Adolescent................................................ 62 Prognosis in Chronic CAD.....................................29 1. Structural Congenital Cardiovascular Disease...... 63 5. Echocardiographic Assessment Before and After G. Arrhythmias/Conduction Disturbances.....................64 Revascularization....................................................33 H. Acquired Cardiovascular Disease............................. 64 I. Pediatric Acquired Cardiopulmonary V. Cardiomyopathy, Congestive Heart Failure, and Cardiovascular Disease.............................................. 65 Assessment of Left Ventricular Function: J. Thrombus/Tumor........................................................66 Echocardiographic Parameters...................................... 34 K. Transesophageal
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