Condition | Level of evidence and strength of recommendation | |
---|---|---|
General recommendations | ||
General | • Large one-off, or stepped changes in parameters, even if they remain in the normal range | IC |
• Measurements that fall outside normal values | IC | |
Arrhythmia | • Any abnormal rhythm, e.g. loss of sinus rhythm, frequent premature ventricular complexes | IC |
Aortopathy | • Any progression of aortic dilatation | IC |
Valvular heart disease | ||
Aortic stenosis | • Any decrease in LVEF, especially if accompanied by fall in transvalvar velocity | IC |
• Any increase in LV systolic or diastolic dimensions | IIC | |
• Tachycardia on echo (> 100 beats per minute) | IC | |
Mitral stenosis | • Any new diagnosis of mitral stenosis • Progression of severity • New onset atrial fibrillation • Left atrial spontaneous contrast or suspicion of thrombus • Any deterioration in RV function, increase in PA pressure or increase in RV dimensions | IC IC IC IC IIC |
Pulmonary stenosis | • Deterioration in RV function • Increasing severity of tricuspid regurgitation | IC IIC |
Mitral regurgitation | • Deterioration in LV function • Increase in LV systolic or diastolic dimensions • Increase in severity of mitral regurgitation | IC IC IC |
Aortic regurgitation | • Deterioration in LV function • Increase in LV systolic or diastolic dimensions • Increase in severity of aortic regurgitation | IC IC IC |
Pulmonary regurgitation | • Progressive increase in RV dimensions • Reduction in RV systolic function • Increasing severity of tricuspid regurgitation | IIC IC IIC |
Tricuspid regurgitation | • Progressive increase in RV dimensions • Reduction in RV systolic function • Increasing severity of tricuspid regurgitation | IIC IC IIC |
Prosthetic valves | • Any suspicion of mechanical valve dysfunction suggesting possible valve thrombosis • Other imaging modalities (fluoroscopy and/or TOE, rarely CTa) should be considered | IC IIC |
Cardiomyopathy | ||
PPCM | • New LV dysfunction | IC |
• Serial reduction in LV function | IC | |
• Serial increase in LV dimensions | IC | |
• Evidence of abnormalities associated with poor prognosis including: | ||
• LVEF ≤ 30% | IC | |
• LVEDd ≥ 6 cm | IC | |
• RV dilatation and dysfunction | IIC | |
Dilated cardiomyopathy and previous PPCM | • Serial reduction in LV function • Serial increase in LV dimensions | IC IC |
Hypertrophic cardiomyopathy | • Newly detected LVOT obstruction • Deterioration in systolic or diastolic LV function • Increase in E/e’ • Loss of sinus rhythm | IC IC IIC IIC |
Arrhythmogenic cardiomyopathy | • Deterioration in ventricular function • Increase in degree of tricuspid regurgitation • Frequent or complex ventricular ectopy | IC IIC IIC |
Pulmonary arterial hypertension | • Any deterioration in RV function • Evidence of rising pulmonary artery pressure • Progressive tricuspid regurgitation | IC IC IIC |
Congenital heart disease | ||
Tetralogy of Fallot | • Deterioration in RV function • Progressive tricuspid regurgitation | IC IIC |
Transposition of the great arteries (dTGA) | Post arterial switch operation: | |
• New LV dysfunction | IC | |
• Progressive dilatation of neo aortic root or aortic regurgitation | IIC | |
• If right-sided obstruction, worsening of RV function or progressive TR | IIC | |
Post Senning or Mustard repair: | ||
• Deterioration in systemic RV function | IC | |
• Progression of systemic tricuspid regurgitation | IIC | |
Post Rastelli operation: | ||
• New LV dysfunction | IIC | |
Congenitally corrected TGA | • New or deteriorating systemic RV dysfunction • Progressive systemic tricuspid regurgitation | IC IIC |
Fontan circulation | • New or deteriorating ventricular dysfunction • New or deteriorating atrioventricular valve regurgitation • Loss of sinus rhythm | IIC IIC IIC |