The Living Guidelines: Recommendations for Echocardiography, Treadmill Exercise Testing, Stress Radionuclide Imaging, Stress Echocardiography Studies, and Coronary Angiography during Patient Follow-up Suggest Revisions to the CLASS I Guidelines

1. Chest X-ray for patients with evidence of new or worsening congestive heart failure (CHF). (Class I Level of Evidence: C)

2. Assessment of left ventricular ejection fraction (LV EF) and segmental wall motion by echocardiography or radionuclide imaging in patients with new or worsening congestive heart failure or evidence of intervening myocardial infarction by history or ECG. (Class I Level of Evidence: C)

3. Echocardiography for evidence of new or worsening valvular heart disease. (Class I Level of Evidence: C)

4. Treadmill exercise test for patients without prior revascularization who have a significant change in clinical status, are able to exercise, and do not have any of the following ECG abnormalities. (Class I Level of Evidence: C)

a. Pre-excitation (Wolff-Parkinson-White) syndrome. (Class I Level of Evidence: C)

b. Electronically paced ventricular rhythm. (Class I Level of Evidence: C)

c. More than 1 mm of rest ST depression. (Class I Level of Evidence: C)

d. Complete left bundle branch block (LBBB). (Class I Level of Evidence: C)

5. Stress radionuclide imaging or stress echocardiography procedures for patients without prior revascularization who have a significant change in clinical status and are unable to exercise or have one of the following ECG abnormalities:

a. Pre-excitation (Wolff-Parkinson-White) syndrome. (Class I Level of Evidence: C)

b. Electronically paced ventricular rhythm. (Class I Level of Evidence: C)

c. More than 1 mm of rest ST depression. (Class I Level of Evidence: C)

d. Complete left bundle-branch block. (Class I Level of Evidence: C)

6. Stress radionuclide imaging or stress echocardiography procedures for patients who have a significant change in clinical status and required a stress imaging procedure on their initial evaluation because of equivocal or intermediate-risk treadmill results. (Class I Level of Evidence: C)

7. Stress radionuclide imaging or stress echocardiography procedures for patients with prior revascularization who have a significant change in clinical status. (Class I Level of Evidence: C)

8. Coronary angiography in patients with marked limitation of ordinary activity (CCS class III) despite maximal medical therapy. (Class I Level of Evidence: C)