Stress protocols are harmonized according to recent European and North-American scientific societies' guidelines, with semi-supine exercise recommended and pharmacological stress dosages up to 40 mcg/kg/min for dobutamine, up to 0.84 mg/kg in 6 min for dipyridamole, and up to a 4-min step of 200 microg/kg/min for adenosine [ 5, 6 ]. The clinical use of contrast echocardiography (ECHO) is appropriate in selected patients to: Evaluate myocardial ischemia Quantify myocardial perfusion during stress Identify the "area at risk" during acute myocardial infarction (AMI) Determine the success of reperfusion interventions Assess myocardial viability By Jill M. Young, CPC, CEDC, CIMC. When reported to Medicare, cardiac (93015-93024) and pulmonary (94620-94621) stress tests must meet applicable supervision requirements. You also must remember that in the outpatient setting only a physician—never a non-physician practitioner (NPP)—may act as the supervising entity for diagnostic tests. intervention is appropriate for patients with lflg severe as and lvef 20-49% with flow reserve on low-dose dobutamine stress echocardiography (dse); intervention is appropriate or balloon aortic valvotomy (bav) or no intervention may be considered for patients with no flow reserve, but with a very calcified aortic valve suggestive of truly severe … Your stress echo code choices are as follows, per the 2017 CPT ® manual: 93350, Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report Low-dose dobutamine stress echocardiography (DSE) is appropriate among symptomatic patients with low-flow, low-gradient severe AS and low left ventricular ejection fraction (LVEF). TEE or CMR are appropriate patients with suspicion of severe MR or AR that is potentially underestimated on TTE. Roxy Senior, Harald Becher, Mark Monaghan, Luciano Agati, Jose Zamorano, Jean Louis Vanoverschelde, Petros Nihoyannopoulos, Thor Edvardsen, Patrizio Lancellotti, Reviewers: This document was reviewed by members of the EACVI Scientific Documents Committee for 2014-16 and 2016-18, Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection Commonly Used Radiopharmaceuticals In classical LFLG, it is recommended to perform a low‐dose dobutamine stress echocardiography (DSE): (1) To assess the presence of LV flow reserve (FR) and (2) To differentiate true‐severe versus pseudo‐severe AS. 1 The 2017 European Guidelines 2 recommend AVR (Class I) in classical LFLG AS (LVEF <50%, AVA <1.0 cm 2, and mean gradient <40 SCMR Standardized Imaging Protocols 2020 Update. SCMR Position Statement: Clinical Practice of CMR 2019. SCMR Consensus Statement on CMR Mapping of T1, T2, and T2* 2017. 4D flow cardiovascular magnetic resonance consensus statement 2015. SCMR T1 Mapping Position Statement 2013. SCMR Standardized Post-Processing 2013. ase/sca guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiogra