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Brief Summary

GUIDELINE TITLE

ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/ASNC Committee to revise the 1995 guidelines for the clinical use of cardiac radionuclide imaging).

BIBLIOGRAPHIC SOURCE(S)

  • ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/ASNC Committee to revise the 1995 guidelines [trunc]. Bethesda (MD): American College of Cardiology Foundation; 2003. 69 p. [519 references]

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Ritchie JL, Bateman TM, Bonow RO, Crawford MH, Gibbons RJ, Hall RJ, O'Rourke RA, Parisi AF, Verani MS. Guidelines for clinical use of cardiac radionuclide imaging. Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Radionuclide Imaging), J Am Coll Cardiol 1995 Feb;25(2):521-47.

These guidelines will be reviewed 1 year after publication and yearly thereafter and considered current unless the Task Force on Practice Guidelines revises or withdraws them from circulation.

BRIEF SUMMARY CONTENT

 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Definitions for the weight of the evidence (A-C) and classes of recommendations (I-III) can be found at the end of the "Major Recommendations" field.

Abbreviations: ACS, acute coronary syndrome; CABG, coronary artery bypass graft surgery; CAD, coronary artery disease; CCS, coronary calcium score; CT, computed tomography; ECG, electrocardiogram; FDG, flurodeoxyglucose; FPRNA, first pass radionuclide angiography; LBBB, left bundle-branch block; LV, left ventricular or left ventricle; LVH, left ventricular hypertrophy; MPHR, maximal-predicted heart rate; MPI, myocardial perfusion imaging; PCI, percutaneous coronary intervention; PET, positron emission tomography; RNA, radionuclide angiogram; RV, right ventricular or right ventricle; SPECT, single-photon emission computed tomography; STEMI, ST-segment elevation myocardial infarction; Tc-99m, technetium-99m; Tl-201, thallium-201

Recommendations for Emergency Department Imaging for Suspected Acute Coronary Syndromes (ACS)

Indication Test Class Level of Evidence
1. Assessment of myocardial risk in possible ACS patients with nondiagnostic ECG and initial serum markers and enzymes, if available. Rest MPI I A
2. Diagnosis of CAD in possible ACS patients with chest pain with nondiagnostic ECG and negative serum markers and enzymes or normal resting scan. Same day rest/stress perfusion imaging I B
3. Routine imaging of patients with myocardial ischemia/necrosis already documented clinically, by ECG and/or serum markers or enzymes Rest MPI III C

Abbreviations: ACS, acute coronary syndromes; CAD, coronary artery disease; ECG, electrocardiogram; MPI, myocardial perfusion imaging

Recommendations for Use of Radionuclide Testing in Diagnosis, Risk Assessment, Prognosis, and Assessment of Therapy After Acute ST-Segment Elevation Myocardial Infarction (STEMI)

Patient Subgroup(s) Indication Test Class Level of Evidence
All 1. Rest LV function Rest RNA or EGC-gated SPECT I B
Thrombolytic therapy without catheterization 2. Detection of inducible ischemia and myocardium at risk Stress MPI with ECG-gated SPECT whenever possible I B
Acute STEMI 3. Assessment of infarct size and residual viable myocardium MPI at rest or with stress using gated SPECT I B
4. Assessment of RV function with suspected RV infarction Equilibrium or FPRNA IIa B

Abbreviations: ECG, electrocardiography; FPRNA, first-pass radionuclide angiography; LV, left ventricular; MPI, myocardial perfusion imaging; RNA, radionuclide angiography; RV, right ventricular; SPECT, single-photon emission computed tomography; STEMI, ST-segment elevation myocardial infarction

Recommendations for Use of Radionuclide Testing for Risk Assessment/Prognosis in Patients With Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA)

Indication Test Class Level of Evidence
1. Identification of inducible ischemia in the distribution of the "culprit lesion" or in remote areas in patients at intermediate or low risk for major adverse cardiac events. Stress MPI with ECG gating whenever possible I B
2. Identification of the severity/extent of inducible ischemia in patients whose angina is satisfactorily stabilized with medical therapy or in whom diagnosis is uncertain. Stress MPI with ECG gating whenever possible I A
3. Identification of hemodynamic significance of coronary stenosis after coronary arteriography. Stress MPI I B
4. Measurement of baseline LV function. RNA or gated SPECT I B
5. Identification of the severity/extent of disease in patients with ongoing suspected ischemia symptoms when ECG changes are nondiagnostic. Rest MPI IIa B

Abbreviations: ECG, electrocardiography; LV, left ventricular; MPI, myocardial perfusion imaging; RNA, radionuclide angiography; SPECT, single-photon emission computed tomography

Cardiac Stress Myocardial Perfusion Single-Photon Emission Computed Tomography (SPECT) in Patients Able to Exercise

Recommendations for Diagnosis of Patients With an Intermediate Likelihood of Coronary Artery Disease (CAD) and/or Risk Stratification of Patients With an Intermediate or High Likelihood of CAD Who Are Able to Exercise (to at least 85% of Maximal Predicted Heart Rate)

Class I

  1. Exercise myocardial perfusion SPECT to identify the extent, severity, and location of ischemia in patients who do not have left bundle-branch block (LBBB) or an electronically-paced ventricular rhythm but do have a baseline electrocardiogram (ECG) abnormality that interferes with the interpretation of exercise-induced ST-segment changes (ventricular pre-excitation, left ventricular hypertrophy [LVH], digoxin therapy, or more than 1-mm ST depression) (Level of Evidence: B)
  2. Adenosine or dipyridamole myocardial perfusion SPECT in patients with LBBB or electronically-paced ventricular rhythm (Level of Evidence: B)
  3. Exercise myocardial perfusion SPECT to assess the functional significance of intermediate (25 to 75%) coronary lesions (Level of Evidence: B)
  4. Exercise myocardial perfusion SPECT in patients with intermediate Duke treadmill score (Level of Evidence: B)
  5. Repeat exercise myocardial perfusion imaging after initial perfusion imaging in patients whose symptoms have changed to redefine the risk for cardiac event (Level of Evidence: C)

Class IIa

  1. Exercise myocardial perfusion SPECT at 3 to 5 years after revascularization (either percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) in selected high-risk asymptomatic patients (Level of Evidence: B)
  2. Exercise myocardial perfusion SPECT as the initial test in patients who are considered to be at high risk (patients with diabetes or patients otherwise defined as having a more than 20% 10-year risk of a coronary heart disease event) (Level of Evidence: B)

Class IIb

  1. Repeat exercise myocardial perfusion SPECT 1 to 3 years after initial perfusion imaging in patients with known or a high likelihood of CAD and stable symptoms and a predicted annual mortality of more than 1% to redefine the risk of a cardiac event (Level of Evidence: C)
  2. Repeat exercise myocardial perfusion SPECT on cardiac active medications after initial abnormal perfusion imaging to assess the efficacy of medical therapy (Level of Evidence: C)
  3. Exercise myocardial perfusion SPECT in symptomatic or asymptomatic patients who have severe coronary calcification (computed tomography [CT] coronary calcium score more than the 75th percentile for age and sex) in the presence on the resting ECG of pre-excitation [Wolff-Parkinson-White syndrome] or more than 1 mm ST-segment depression (Level of Evidence: B)
  4. Exercise myocardial perfusion SPECT in asymptomatic patients who have a high-risk occupation. (Level of Evidence: B)

Cardiac Stress Myocardial Perfusion SPECT in Patients Unable to Exercise

Recommendations for Diagnosis of Patients With an Intermediate Likelihood of CAD and/or Risk Stratification of Patients With an Intermediate or High Likelihood of CAD Who Are Unable to Exercise.

Class I

  1. Adenosine or dipyridamole myocardial perfusion SPECT to identify the extent, severity, and location of ischemia. (Level of Evidence: B)
  2. Adenosine or dipyridamole myocardial perfusion SPECT to assess the functional significance of intermediate (25 to 75%) coronary lesions (Level of Evidence: B)
  3. Adenosine or dipyridamole myocardial perfusion SPECT after initial perfusion imaging in patients whose symptoms have changed to redefine the risk for cardiac event (Level of Evidence: C)

Class IIa

  1. Adenosine or dipyridamole myocardial perfusion SPECT at 3 to 5 years after revascularization (either PCI or CABG) in selected high-risk asymptomatic patients (Level of Evidence: B)
  2. Adenosine or dipyridamole myocardial perfusion SPECT as the initial test in patients who are considered to be at high risk (patients with diabetes or patients otherwise defined as having a more than 20% 10-year risk of a coronary heart disease event). (Level of Evidence: B)
  3. Dobutamine myocardial perfusion SPECT in patients who have a contraindication to adenosine or dipyridamole (Level of Evidence: C)

Class IIb

  1. Repeat adenosine or dipyridamole myocardial perfusion imaging 1 to 3 years after initial perfusion imaging in patients with known or a high likelihood of CAD and stable symptoms, and a predicted annual mortality of more than 1%, to redefine the risk of a cardiac event (Level of Evidence: C)
  2. Repeat adenosine or dipyridamole myocardial perfusion SPECT on cardiac active medications after initial abnormal perfusion imaging to assess the efficacy of medical therapy (Level of Evidence: C)
  3. Adenosine or dipyridamole myocardial perfusion SPECT in symptomatic or asymptomatic patients who have severe coronary calcification (CT Coronary Calcium Score more than the 75th percentile for age and sex) in the presence on the resting ECG of LBBB or an electronically-paced ventricular rhythm (Level of Evidence: B)
  4. Adenosine or dipyridamole myocardial perfusion SPECT in asymptomatic patients who have a high-risk occupation (Level of Evidence: C)

Cardiac Stress Myocardial Perfusion Positron Emission Tomography (PET)

Recommendations for Diagnosis of Patients With an Intermediate Likelihood of CAD and/or Risk Stratification of Patients With an Intermediate or High Likelihood of CAD

Class I

  1. Adenosine or dipyridamole myocardial perfusion PET in patients in whom an appropriately indicated myocardial perfusion SPECT study has been found to be equivocal for diagnostic or risk stratification purposes (Level of Evidence: B)

Class IIa

  1. Adenosine or dipyridamole myocardial perfusion PET to identify the extent, severity, and location of ischemia as the initial diagnostic test in patients who are unable to exercise (Level of Evidence: B)
  2. Adenosine or dipyridamole myocardial perfusion PET to identify the extent, severity, and location of ischemia as the initial diagnostic test in patients who are able to exercise but have LBBB or an electronically-paced rhythm (Level of Evidence: B)

Cardiac Stress Perfusion Imaging Before Noncardiac Surgery

Recommendations

Class I

  1. Initial diagnosis of CAD in patients with intermediate pretest probability of disease and abnormal baseline ECG* or inability to exercise (Level of Evidence: B)
  2. Prognostic assessment of patients undergoing initial evaluation for suspected or proven CAD with abnormal baseline ECG* or inability to exercise (Level of Evidence: B)
  3. Evaluation of patients following a change in clinical status (e.g., acute coronary syndrome [ACS]) with abnormal baseline ECG* or inability to exercise (Level of Evidence: B)
  4. Initial diagnosis of CAD in patients with LBBB and intermediate pretest probability of disease, when used in conjunction with vasodilator stress (Level of Evidence: B)
  5. Prognostic assessment of patients with LBBB undergoing initial evaluation for suspected or proven CAD, when used in conjunction with vasodilator stress (Level of Evidence: B)
  6. Assessment of patients with intermediate or minor clinical risk predictors** and poor functional capacity (less than 4 metabolic equivalent [METS]) who require high-risk noncardiac surgery***, when used in conjunction with pharmacologic stress (Level of Evidence: C)
  7. Assessment of patients with intermediate clinical risk predictors**, abnormal baseline ECGs*, and moderate or excellent functional capacity (more than 4 METS) who require high-risk noncardiac surgery (Level of Evidence: C)

*Baseline ECG abnormalities that interfere with interpretation of exercise-induced ST-segment changes include LBBB, ventricular pre-excitation, ventricular pacing, LVH with repolarization changes, more than 1-mm ST depression, and digoxin therapy.

**As defined in the ACC/AHA Guideline Update for Perioperatiave Cardiovascular Evaluation for Noncardiac Surgery, intermediate clinical risk predictors include mild angina, prior myocardial infarction (MI), compensated or prior heart failure, diabetes, and renal insufficiency. Minor clinical risk predictors include advanced age, abnormal ECG, rhythm other than sinus, low functional capacity, history of cerebrovascular accident, and uncontrolled hypertension.

***High-risk surgery is defined by emergent operations (particularly in the elderly), aortic and other major vascular surgery, peripheral vascular surgery, and other prolonged operations in which major fluid shifts are anticipated (i.e., reported cardiac risk often more than 5%).

Class IIb

  1. Routine assessment of active, asymptomatic patients who have remained stable for up to 5 years after CABG surgery (Level of Evidence: C)
  2. Routine evaluation of active asymptomatic patients who have remained stable for up to 2 years after previous abnormal coronary angiography or noninvasive assessment of myocardial perfusion (Level of Evidence: C)
  3. Diagnosis of restenosis and regional ischemia in active asymptomatic patients within weeks to months after PCI (Level of Evidence: C)
  4. Initial diagnosis or prognostic assessment of CAD in patients with right bundle-branch block or less than 1-mm ST depression on resting ECG (Level of Evidence: C)

Class III

  1. Routine screening of asymptomatic men or women with low pretest likelihood of CAD (Level of Evidence: C)
  2. Evaluation of patients with severe comorbidities that limit life expectancy or candidacy for myocardial revascularization (Level of Evidence: C)
  3. Initial diagnosis or prognostic assessment of CAD in patients who require emergency noncardiac surgery (Level of Evidence: C)

Recommendations for Use of Radionuclide Imaging in Patients With Heart Failure: Fundamental Assessment

Indication Test Class Level of Evidence
1. Initial assessment of LV and RV function at rest* Rest RNA I A
2. Assessment of myocardial viability for consideration of revascularization in patients with CAD and LV systolic dysfunction who do not have angina MPI (see Table 5), PET I B
3. Assessment of the copresence of CAD in patients without angina MPI IIa B
4. Routine serial assessment of LV and RV function at rest Rest RNA IIb B
5. Initial or serial assessment of ventricular function with exercise Exercise RNA IIb B

*National consensus treatment guidelines are directed by quantitative assessment of LVEF and identification of LVEF less than or equal to 40%.

Abbreviations: CAD, coronary artery disease; LV, left ventricular; MPI, myocardial perfusion imaging; PET, positron emission tomography; RNA, radionuclide angiography

Recommendations for the Use of Radionuclide Techniques to Assess Myocardial Viability

Indication Test Class Level of Evidence
1. Predicting improvement in regional and global LV function after revascularization Stress/redistribution/reinjection 201TI I B
Rest-redistribution imaging I B
Perfusion plus PET FDG imaging I B
Resting sestamibi imaging I B
Gated SPECT sestamibi imaging IIa B
Late 201Tl redistribution imaging (after stress) IIb B
Dobutamine RNA IIb C
Postexercise RNA IIb C
Postnitroglycerin RNA IIb C
2. Predicting improvement in heart failure symptoms after revascularization. Perfusion plus PET FDG imaging IIa B
3. Predicting improvement in natural history after revascularization 201TI imaging (rest-redistribution and stress/redistribution/reinjection) I B
Perfusion plus PET FDG imaging Ia B

Abbreviations: FDG, flurodeoxyglucose; PET, positron emission tomography; RNA, radionuclide angiography; SPECT, single-photon emission computed tomography; 201Tl, thallium-201

Recommendations for the Use of Radionuclide Imaging to Diagnose Specific Causes of Dilated Cardiomyopathy

Indication Test Class Level of Evidence
1. Baseline and serial monitoring of LV function during therapy with cardiotoxic drugs (e.g., doxorubicin) Rest RNA I A
2. RV dysplasia Rest RNA IIa B
3. Assessment of posttransplant obstructive CAD Exercise perfusion imaging IIb B
4. Diagnosis and serial monitoring of Chagas disease Exercise perfusion imaging IIb B
5. Diagnosis of amyloid heart disease 99mTc-pyrophosphate imaging IIb B
6. Diagnosis and serial monitoring of sarcoid heart disease Rest perfusion imaging IIb B
Rest 67Ga imaging IIb B
7. Detection of myocarditis Rest 67Ga imaging IIb B
111In antimyosin antibody imaging IIb C

Abbreviations: 67Ga, gallium-67; 99mTc-pyrophosphate, Tc-99m-pyrophosphate; 111In, indium-111; CAD, coronary artery disease; LV, left ventricular; RNA, radionuclide angiography; RV, right ventricular

Recommendations for the Use of Radionuclide Imaging to Evaluate Hypertrophic Heart Disease

Indication Test Class Level of Evidence
1. Diagnosis of CAD in hypertrophic cardiomyopathy Rest and exercise perfusion imaging IIb B
2. Diagnosis and serial monitoring of hypertensive hypertrophic heart disease Rest RNA IIb B
3. Diagnosis and serial monitoring of hypertrophic cardiomyopathy, with and without outflow obstruction Rest RNA III B

Abbreviations: CAD, coronary artery disease; RNA, radionuclide angiography

Recommendations for the Use of Radionuclide Imaging in Valvular Heart Disease

Indication Test Class Level of Evidence
1. Initial and serial assessment of LV and RV function Rest RNA I B
2. Initial and serial assessment of LV function Exercise RNA IIb B
3. Assessment of the copresence of coronary disease MPI IIb B

Abbreviations: LV, left ventricular; RNA, radionuclide imaging angiography; RV, right ventricular; MPI, myocardial perfusion imaging

Recommendations for the Use of Radionuclide Imaging in Adults with Congenital Heart Disease

Indication Test Class Level of Evidence
1. Initial and serial assessment of LV and RV function Rest RNA I B
2. Shunt detection and quantification FPRNA IIa B

Abbreviations: FPRNA, first-pass radionuclide angiography; LV, left ventricular; RV, right ventricular; RNA, radionuclide angiography

Definitions:

Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective

Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment

Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy

Class IIb: Usefulness/efficacy is less well established by evidence/opinion

Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful

Strength of Evidence

  1. Data derived from multiple randomized clinical trials
  2. Data derived from a single randomized trial, or from nonrandomized trials
  3. Consensus opinion of experts

CLINICAL ALGORITHM(S)

None provided

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EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

Recommendations in this guideline are derived from the literature search results. The type of supporting evidence is identified with each recommendation (see "Major Recommendations" field).

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IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/ASNC Committee to revise the 1995 guidelines [trunc]. Bethesda (MD): American College of Cardiology Foundation; 2003. 69 p. [519 references]

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

1995 Feb (revised 2003 Aug)

GUIDELINE DEVELOPER(S)

American College of Cardiology Foundation - Medical Specialty Society
American Heart Association - Professional Association
American Society of Nuclear Cardiology - Professional Association

SOURCE(S) OF FUNDING

The American College of Cardiology and the American Heart Association. No outside funding accepted.

GUIDELINE COMMITTEE

American College of Cardiology (ACA)/American Heart Association )AHA)/American Society of Nuclear Cardiology (ASNC) Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

The committee membership consisted of acknowledged experts in radionuclide testing, as well as general cardiologists and cardiologists with expertise in other imaging modalities: both the academic and private practice sectors were represented.

Committee Members: Francis J. Klocke, MD, MACC, FAHA (Chair); Michael G. Baird, MD, FACC, FAHA; Timothy M. Bateman, MD, FACC, FAHA; Daniel S. Berman, MD, FACC, FAHA; Blase A. Carabello, MD, FACC, FAHA; Manuel D. Cerqueira, MD, FACC, FAHA; Anthony N. DeMaria, MD, MACC, FAHA; J. Ward Kennedy, MD, MACC, FAHA; Beverly H. Lorell, MD, FACC, FAHA; Joseph V. Messer, MD, MACC, FAHA; Patrick T. O'Gara, MD, MACC, FAHA; Richard O. Russell, Jr., MD, FACC; Martin G. St. John Sutton, MBBS, FACC; James E. Udelson, MD, FACC; Mario S. Verani, MD, FACC*; Kim Allan Williams, MD, FACC, FAHA

Task Force Members: Elliott M. Antman, MD, FACC, FAHA (Chair); Sidney C. Smith, Jr., MD, FACC, FAHA (Vice Chair); Joseph S. Alpert, MD, FACC, FAHA; Gabriel Gregoratos, MD, FACC, FAHA; Jeffrey L. Anderson, MD, FACC; David P. Faxon, MD, FACC, FAHA; Valentin Fuster, MD, PhD, FACC, FAHA; Raymond J. Gibbons, MD, FACC, FAHA**#; Loren F. Hiratzka, MD, FACC, FAHA; Sharon Ann Hunt, MD, FACC, FAHA; Alice K. Jacobs, MD, FACC, FAHA; Richard O. Russell, MD, FACC, FAHA**

*Deceased
**Former Task Force Member
#Former Task Force Chair

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The American College of Cardiology/American Heart Association Task Force on Practice Guidelines makes every effort to avoid any actual or potential conflicts of interest that might arise as a result of an outside relationship or personal interest of a member of the writing panel. Specifically, all members of the writing panel are asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest. These statements are reviewed by the parent task force, reported orally to all members of the writing panel at the first meeting, and updated as changes occur.

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Ritchie JL, Bateman TM, Bonow RO, Crawford MH, Gibbons RJ, Hall RJ, O'Rourke RA, Parisi AF, Verani MS. Guidelines for clinical use of cardiac radionuclide imaging. Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Radionuclide Imaging), J Am Coll Cardiol 1995 Feb;25(2):521-47.

These guidelines will be reviewed 1 year after publication and yearly thereafter and considered current unless the Task Force on Practice Guidelines revises or withdraws them from circulation.

GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the American College of Cardiology (ACC) Web site.

Copies are also available from the American Heart Association (AHA) Web site.

Print copies: Available from ACC, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Also available from AHA, Public Information 7272 Greenville Avenue, Dallas, TX 75231-4596 (Reprint No. 71-0112).

AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

  • ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003 Oct 1;42(7):1318-33; Circulation. 2003 Sep 16;108(11):1404-18.

Electronic copies: Available from the American College of Cardiology (ACC) Web site in Portable Document Format (PDF).

Print copies: Available from ACC, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Also available from AHA, Public Information 7272 Greenville Avenue, Dallas, TX 75231-4596 (Reprint No. 71-0112).

PATIENT RESOURCES

None provided

NGC STATUS

This summary was completed by ECRI on June 30, 1998. The information was verified by the guideline developer on December 1, 1998. This summary was updated by ECRI on March 5, 2004. The updated information was verified by the guideline developer on May 13, 2005.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions as follows:

Copyright to the original guideline is owned by the American College of Cardiology Foundation (ACCF) and the American Heart Association, Inc. (AHA). NGC users are free to download a single copy for personal use. Reproduction without permission of the ACC/AHA guidelines is prohibited. Permissions requests should be directed to Patty Jones, 9111 Old Georgetown Rd, Bethesda, MD 20814-1699; telephone, (800) 253-4636 ext. 368; fax, (301) 897-9745.

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DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.
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