ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy
, Prabhakar Rajiah1, Jacobo Kirsch2
1Mayo Clinic, Rochester, Minnesota.
Insights
Nonischemic cardiomyopathies are heart muscle diseases without ischemia. Guidelines recommend specific imaging tests like echocardiography and MRI for diagnosing five variants, aiding clinical decisions.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Nonischemic cardiomyopathies present diverse myocardial dysfunctions without ischemic origins.
- Five primary variants include hypertrophic, restrictive/infiltrative, dilated/unclassified, arrhythmogenic, and inflammatory cardiomyopathies.
Framework:
- The American College of Radiology Appropriateness Criteria provide evidence-based guidelines.
- These criteria are annually reviewed by a multidisciplinary panel using rigorous methodologies.
- Literature analysis and established methods like RAND/UCLA and GRADE inform recommendations.
Implementation:
- For hypertrophic, dilated, and arrhythmogenic cardiomyopathies (Variants 1, 3, 4), recommended imaging includes echocardiography and cardiac MRI (with/without contrast).
- For restrictive/infiltrative and inflammatory cardiomyopathies (Variants 2, 5), recommended imaging includes echocardiography and cardiac MRI (with/without contrast).
Implications:
- These guidelines standardize diagnostic imaging approaches for nonischemic cardiomyopathies.
- They aim to optimize patient care by ensuring appropriate use of imaging modalities.
- Expert opinion supplements evidence where data is limited, ensuring comprehensive recommendations.
Abstract:
Nonischemic cardiomyopathies encompass a broad spectrum of myocardial disorders with mechanical or electrical dysfunction without evidence of ischemia. There are five broad variants of nonischemic cardiomyopathies; hypertrophic cardiomyopathy (Variant 1), restrictive or infiltrative cardiomyopathy (Variant 2), dilated or unclassified cardiomyopathy (Variant 3), arrhythmogenic cardiomyopathy (Variant 4), and inflammatory cardiomyopathy (Variant 5). For variants 1, 3, and 4, resting transthoracic echocardiography, MRI heart function and morphology without and with contrast, and MRI heart function and morphology without contrast are the usually appropriate imaging modalities. For variants 2 and 5, resting transthoracic echocardiography and MRI heart function and morphology without and with contrast are the usually appropriate imaging modalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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