ACR Appropriateness Criteria^® Dyspnea-Suspected Cardiac Origin

Area of Science:

• Medical Imaging
• Cardiology
• Pulmonology

Background:

• Dyspnea, or shortness of breath, is a common symptom with diverse etiologies.
• Accurate and timely diagnosis is crucial for effective management of dyspnea.
• Existing guidelines may not comprehensively address imaging for all dyspnea variants.

Purpose of the Study:

• To present evidence-based imaging guidelines for five specific clinical scenarios presenting with dyspnea.
• To differentiate imaging recommendations based on suspected underlying cardiac conditions and exclusion of ischemia.
• To provide a framework for appropriate utilization of diagnostic imaging in dyspnea evaluation.

Main Methods:

• The American College of Radiology Appropriateness Criteria were utilized.
• A multidisciplinary expert panel conducted an extensive analysis of current medical literature.
• Well-established methodologies, including RAND/UCLA Appropriateness Method and GRADE, were applied.

Main Results:

• Guidelines were developed for dyspnea related to: heart failure (ischemia not excluded), nonischemic heart failure, valvular heart disease, cardiac arrhythmia, and pericardial disease.
• Recommendations rate the appropriateness of various imaging procedures for each specific clinical scenario.
• Expert opinion supplemented evidence where data was lacking or equivocal.

Conclusions:

• These guidelines offer a structured approach to imaging selection for patients with dyspnea.
• The criteria aim to optimize diagnostic accuracy and resource utilization in evaluating dyspnea.
• The recommendations support informed decision-making for clinicians managing patients with shortness of breath.