ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography

The American College of Cardiology Foundation (ACCF) and the American Society of Echocardiography (ASE), together with key specialty and subspecialty societies, conducted an appropriateness review for transthoracic and transesophageal echocardiography (TTE/TEE). This review assesses the risks and benefits of TTE and/or TEE for several indications or clinical scenarios and scored them based on a scale of 1 to 9. The upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The midrange (4 to 6) indicates a clinical scenario for which the indication for an echocardiogram is uncertain. The indications for this review were drawn from common applications or anticipated uses as well as current clinical practice guidelines. Use of TTE/TEE for initial evaluation of structure and function was viewed favorably, while routine repeat testing and general screening uses in certain clinical scenarios were viewed less favorably. It is anticipated that these results will have a significant impact on physician decision-making and performance, reimbursement policy, and will help guide future research.