《2011年超声心动图合理应用标准》内容预览：

    The American College of Cardiology Foundation (ACCF), in partner-ship with the American Society of Echocardiography (ASE) and alongwith key specialty and subspecialty societies, conducted a review ofcommon clinical scenarios
 
   where echocardiography is fre-quently considered. This docu-ment combines and updates theoriginal transthoracic and transe-sophageal echocardiography ap-propriateness criteria publishedin 2007 (1) and the originalstress echocardiography appro-priateness criteria published in2008 (2). This revision reflectsnew clinical data, reflectschanges in test utilization pat-terns, and clarifies echocardiog-raphy use where omissions orlack of clarity existed in the orig-inal criteria.The indications (clinical sce-narios) were derived from com-mon applications or anticipateduses, as well as from current clin-ical practice guidelines and re-sults of studies examining theimplementation of the originalappropriate use criteria (AUC).The 202 indications in this docu-ment were developed by a di-verse writing group and scoredby a separate independent tech-nical panel on a scale of 1 to 9,to designate appropriate use(median 7 to 9), uncertain use(median 4 to 6), and inappropri-ate use (median 1 to 3).Ninety-seven indications wererated as appropriate, 34 wererated as uncertain, and 71 wererated as inappropriate. In general,the use of echocardiography forinitial diagnosis when there isa change in clinical status orwhen the results of the echocar-diogram are anticipated tochange patient managementwere rated appropriate. Routinetesting when there was nochange in clinical status or whenresults of testing were unlikelyto modify management weremore likely to be inappropriatethan appropriate/uncertain.The AUC for echocardiogra-phy have the potential to impactphysician decision making,healthcare delivery, and reim-bursement policy. Furthermore,recognition of uncertain clinicalscenarios facilitates identificationof areas that would benefit fromfuture research.
PREFACE
  
   In an effort to respond to the need for the rational use of imaging ser-vices in the delivery of high-quality care, the ACCF has undertakena process to determine the appropriate use of cardiovascular imagingfor selected patient indications.AUC publications reflect an ongoing effort by the ACCF tocritically and systematically create, review, and categorize clinicalsituations where diagnostic tests and procedures are utilized byphysicians caring for patients with cardiovascular diseases. Theprocess is based on current understanding of the technical capa-bilities of the imaging modalities examined. Although impossibleto be entirely comprehensive given the wide diversity of clinicaldisease, the indications are meant to identify common scenariosencompassing the majority of situations encountered in contem-porary practice. Given the breadth of ***rmation they convey,the indications do not directly correspond to the NinthRevision of the International Classification of Diseases systemas these codes do not include clinical ***rmation, such as symp-tom status.
The ACCF believes that careful blending of a broad range ofclinical experiences and available evidence-based ***rmation willhelp guide a more efficient and equitable allocation of healthcareresources in cardiovascular imaging. The ultimate objective ofAUC is to improve patient care and health outcomes in a cost-ef-fective manner, but it is not intended to ignore ambiguity and nu-ance intrinsic to clinical decision making. AUC thus should not beconsidered substitutes for sound clinical judgment and practice ex-perience.

   The ACCF AUC process itself is also evolving. In the currentiteration, technical panel members were asked to rate indicationsfor echocardiography in a manner independent and irrespectiveof the prior published ACCF ratings for transthoracic echocardi-ography (TTE) and transesophageal echocardiography (TEE) (1)and stress echocardiography (2) as well as the prior ACCF ratingsfor diagnostic imaging modalities such as cardiac radionuclide im-aging (RNI) (3) and cardiac computed tomography (CT) (4).Given the iterative and evolving nature of the process, readersare counseled that comparison of individual appropriate use rat-ings among modalities rated at different times over the past sev-eral years may not reflect the comparative utility of thedifferent modalities for an indication, as the ratings may varyover time. A comparative evaluation of the appropriate use ofmultiple imaging techniques is currently being undertaken to as-sess the relative strengths of each modality for various clinical sce-narios.

    We are grateful to the technical panel and its chair, Steven Bailey,MD, FACC, FSCAI, FAHA, a professional group with a wide rangeof skills and insights, for their thoughtful and thorough deliberationof the merits of echocardiography for various indications. We wouldalso like to thank the 27 individuals who provided a careful review ofthe draft of indications, the parent AUC Task Force ably led byMichael Wolk, MD, MACC, Rory Weiner, MD, and the ACC staff,John C. L***, MD, Joseph Allen, Starr Webb, Jenissa Haidari, andLea Binder for their exceptionally skilled support in the generationof this document.

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