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J Am Soc Echocardiogr. 2010 Nov;23(11):1199-204. doi: 10.1016/j.echo.2010.07.008. Epub 2010 Aug 19.

Evaluation of the clinical application of the ACCF/ASE appropriateness criteria for stress echocardiography.

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Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.



The aim of this study was to evaluate the clinical application of the American College of Cardiology Foundation and American Society of Echocardiography appropriateness criteria for stress echocardiography (SE) in a single-center university hospital.


Indications were determined for consecutive studies by two reviewers and categorized as appropriate, uncertain, or inappropriate.


Of 477 studies for which primary indications could be determined, 188 specifically related to university transplantation programs were excluded. Of the remaining 289 studies, 88% were addressed in the appropriateness criteria for SE. Of these, 71% were appropriate, 9% were uncertain, and 20% were inappropriate. Inappropriate studies were more likely to be ordered on younger patients and women and were less likely to be ordered by cardiologists. Abnormal results on SE were more frequent among appropriate than inappropriate studies.


The appropriateness criteria for SE encompass and effectively characterize the majority of studies ordered in a single-center university hospital and appear to reasonably stratify the likelihood of abnormal results on SE. However, revisions will be required to fully capture and stratify appropriate clinical practice of SE.

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