Frequency of Echocardiography Testing

o Repeat echocardiograms are no longer supported (annually or otherwise) for evaluation of clinically stable syndromes, including valvular heart disease, evaluation of prosthetic valve, cardiomyopathy, and hypertension.

o Annual testing can be performed for the following when there is evidence for change in clinical status or to assess interventions (medical or surgical):

Ø Assessment of left ventricular hypertrophy progression or regression

Ø Assessment of valve dysfunction

Ø Assessment of cardiac chamber size in cardiomyopathy and atrial dysrhythmias

Ø Assessment of chronic pericardial effusions

Ø Assessment of left ventricular contractility/diastolic function prior to planned medical therapy for heart failure or to evaluate the effectiveness of on-going therapy

§ BNP levels are useful and may alone be sufficient for monitoring in many cases

Ø Assessment of aortic dissection

Ø Assessment of aortic root dilatation

o Testing twice a year should not be routine but can be performed for the
following:

Ø New or changing (not chronic stable) pericardial effusions

Ø Assessment of new/changed medical therapy for congestive heart failure

§ BNP levels are useful and may alone be sufficient for monitoring in many cases

Ø Assessment of new/changed medical therapy for hypertension if left ventricular hypertrophy was present

Ø Assessment of hypertrophic cardiomyopathy when the results of the echo will potentially change patient management

Ø Assessment of critical valvular heart disease when the results of the echo will potentially change patient management

o New Echo can be performed for the following regardless of number of previous Echo studies:

Ø New cardiac murmurs

Ø New myocardial infarction or acute coronary syndrome

Ø New congestive heart failure (or new symptoms of dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema, elevated BNP)

Ø New pericardial disease

Ø New stroke/transient ischemic attack

Ø New aortic dissection (TEE is preferred)

Ø New decompression illness