Table 2.
Suggested prioritization tiers for rescheduling echocardiography examinations
| Priority tier | Basis for priority rating | Examples |
|---|---|---|
| Tier 1 (high priority) | Active or recent change in cardiovascular symptoms | Dyspnea, chest pain, syncope, TIA, new arrhythmia, child with new cardiovascular symptoms and/or cyanosis. |
| Recent procedure requiring urgent follow-up | Post–device implantation arrhythmias or pericardial effusion. Post–cardiac surgery assessment, including VAD complications. | |
| Safety monitoring for therapy (even if asymptomatic) | Chemotherapy, clinical trial safety end point | |
| Echocardiography required before therapy (preoperative, urgent) | Preoperative workup for surgery that is required for significant functional limitation; LVEF assessment before CIED procedure for primary prevention. Baseline assessment before initiation of chemotherapy. | |
| Tier 2 (medium priority) | Asymptomatic but with chronic cardiac disease that requires monitoring for progression | Cardiomyopathy, severe valve disease (AS, MR, AR), pulmonary hypertension, arrhythmias, pericardial effusion. Progression of disease after intervention (recurrent coarctation, conduit stenosis). |
| Therapy that requires ongoing monitoring | Pulmonary artery systolic pressure estimation in patients receiving parenteral therapy for pulmonary hypertension. Antirejection therapy after cardiac transplantation. Treatment for Kawasaki disease. Follow-up assessment of VAD function in stable patients. | |
| Echocardiography required before therapy (preoperative but nonurgent) | Preoperative workup for nonurgent surgery | |
| Tier 3 (low priority) | Routine follow-up for chronic disease | Hypertension, coronary artery disease; annual evaluation for aortic disease or prosthetic valve function (normal function on prior examination and no new symptoms) |
AR, Aortic regurgitation; AS, aortic stenosis; CIED, cardiac implantable electrical device; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; TIA, transient ischemic attack; VAD, ventricular assist device.
Additional issues that are not explicitly listed may also affect prioritization, including duration of test deferral and whether echocardiography is needed before further nonurgent therapy. Integration of these factors should also be considered when rescheduling patients. Consultation with referring provider is encouraged if priority of echo study is unclear.