Table 3.

Role of Cardiovascular Imaging Specific to the COVID-19 Era: Minimize Risk, Reduce Resource Utilization, and Maximize Clinical Benefit

Condition	Indication	TTE	TEE	CTA	CMR	Nuclear Cardiology (SPECT/PET)∗
CAD/myocardial injury	After STEMI intervention in selected COVID-19(+)	++++	x	x	+	x
	Stable NSTEMI/ACS •COVID-19(+) or suspected‡ •Low risk for COVID-19	++++ ++++	x x	++† ++++	+† ++++	+† ++++
	Chest pain with •Clinical suspicion of CAD •Known CAD	+++ ++	x x	++++ ++	++++ ++++	++++ ++++
Cardiomyopathy/arrhythmias	New onset heart failure/cardiomyopathy	++++	+	+++	++++	+++
	Myocardial viability imaging	+	x	+	++++	++++
	LAA evaluation prior to restoration of sinus rhythm	x	++†	++++	++	x
Valvular/structural	Endocarditis (native or prosthetic valve)	+++	++++	++	++	++
	Endocarditis, invasive complications (e.g., abscess, pseudoaneurysm)	++	++++	++++	++	++
	Prosthetic valve dysfunction (pannus, thrombus, calcification)	++++	++†	++++	+	x
	Structural intervention planning •TAVR, LAA occlusion •Mitral and tricuspid valve repair	+++ ++++	+† ++++	++++ ++	++ ++	x x
Masses/other	Cardiac mass evaluation	++++	++†	+++	++++	+
	Pericardial diseases	++++	+†	+++	++++	x

All clinical scenarios in the table assume no active or symptomatic COVID-19 disease, unless otherwise specified. 1+ to 4+ denote a measure of suitability for use during the peri–COVID-19 pandemic period and not necessarily a determination of any inherent diagnostic superiority of one modality over another or comparative efficacy. Strength of the indication and use of a test (1+ to 4+; X = rarely, if at all) and its traditional appropriateness for the clinical condition may be modified by the COVID-19 pandemic as noted. The table summarizes most common clinical indications relevant during the pandemic and cannot capture all nuances in clinical presentations which may affect appropriate test use.

(+) = positive; ACS = acute coronary syndrome; CAD = coronary artery disease; CTA = computed tomography angiography; LAA = left atrial appendage; NSTEMI = non–ST-segment elevation myocardial infarction; STEMI = ST-segment elevation myocardial infarction; TAVR = transaortic valve replacement; other abbreviations as in Tables 1 and 2.

^∗Stress echocardiography has similar scoring to stress nuclear for the CAD and cardiomyopathy indications on this table. The stress type for all imaging modalities, where applicable, is pharmacological stress. Exercise stress has specific considerations during the active pandemic.

^†Reduced test use or priority compared with other tests because of COVID-19 risk exposure or need for more PPE. This reduction in use will undoubtedly lessen and be back to usual practices once the active infection rate of COVID-19 in the community is low and the pandemic is controlled.

^‡Intensified medical therapy and conservative approach when possible in view of COVID-19 status.