A collection of medical societies has released the first appropriate use criteria (AUC) on performing follow-up imaging in patients with congenital heart disease (CHD).
The 47-page document, published Jan. 6 in the Journal of the American College of Cardiology, touches on multiple cardiac imaging modalities, rating them based on their appropriateness for examining adults and children with previously diagnosed heart defects.
Although there have been major advances in the diagnosis and treatment of patients with CHD, a number of them are still forced to endure lifelong follow-up or catheter-based interventions. Noninvasive cardiac imaging, the authors wrote, can play a “key” role in this process, thanks to advances in transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), cardiovascular magnetic resonance, cardiovascular computed tomography and stress imaging.
TTE, generally the most commonly used modality in CHD patients, was rated “appropriate” for routine surveillance of a small atrial septal defect, a single anomalous pulmonary vein or more than one anomalous pulmonary vein. The same modality, along with TEE, however, were deemed “rarely appropriate” for routine surveillance of asymptomatic patients with patent foramen ovale—a birth condition that causes a hole in the wall between the heart’s upper chambers.
“This AUC document will provide guidance to clinicians in the care of patients with established CHD by identifying the reasonable imaging modality options available for evaluation and surveillance of such patients,” the authors wrote. “It will also serve as an educational and quality improvement tool to identify patterns of care and reduce the number of rarely appropriate tests in clinical practice.”
The document was spearheaded by the American Heart Association, and created in collaboration with the American Society of Echocardiography, the Heart Rhythm Society, the International Society for Adult Congenital Heart Disease, the Society for Cardiovascular Angiography and Interventions, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance and the Society of Pediatric Echocardiography.
For a more in-depth breakdown of imaging recommendations read the full document here.