The Living Guidelines: Recommendations for Monitoring of symptoms and anti anginal therapy during follow up Suggest Revisions to the CLASS III Guidelines

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Class III Guidelines
1. Echocardiography or radionuclide imaging for assessment of left ventricular ejection fraction and segmental wall motion in patients with a normal ECG, no history of myocardial infarction, and no evidence of congestive heart failure (CHF). (Class III Level of Evidence: C)

2. Repeat treadmill exercise testing in <3 years in patients who have no change in clinical status and an estimated annual mortality rate <1% on their initial evaluation, as demonstrated by one of the following:


 * a. Low risk Duke Treadmill score (without imaging) (Class III Level of Evidence: C)


 * b. Low risk Duke Treadmill score with negative imaging. (Class III Level of Evidence: C)


 * c. Normal left ventricular function and a normal coronary angiogram. (Class III Level of Evidence: C)


 * d. Normal left ventricular function and insignificant coronary artery disease (Class III Level of Evidence: C)

3. Stress imaging or echocardiography for patients who have no change in clinical status and a normal rest ECG, are not taking digoxin, are able to exercise, and did not require a stress imaging or echocardiographic procedure on their initial evaluation because of equivocal or intermediate-risk treadmill results. (Class III Level of Evidence: C)

4. Repeat coronary angiography in patients with no change in clinical status, no change on repeat exercise testing or stress imaging, and insignificant coronary artery disease on initial evaluation. (Class III Level of Evidence: C)